Treatment begins as soon as possible after chronic myeloid leukemia is found. Doctors will treat any associated symptoms, such as fever and infections, anemia, or risk of bleeding.
Treatment for CML may include medicines called tyrosine kinase inhibitors (TKI). These drugs are taken by mouth every day, and often work very well and have few side effects.
A drug called hydroxyurea may be used at first, along with TKI therapy, to reduce the number of white blood cells in the bloodstream. After a time, the hydroxyurea is stopped and the TKI therapy continues. TKI therapy clears out CML cells and allows normal cells to fill up the marrow and blood system. Patients can stay on TKI therapy indefinitely, but are checked regularly for side effects and to confirm that there are no CML cells remaining.
Watching how your child responds to medicines is a key part of CML treatment. Doctors will test your child’s blood and/or bone marrow at certain times to track response to therapy and to help guide long-term management. When disease is no longer detected, your child is considered “in remission.” Many patients remain in remission on TKI therapy for many years.
If a child’s CML returns after a period of remission, switching to a different TKI medication can often put the CML back into remission.
Even with treatment, CML can sometimes progress to more aggressive forms of the disease. There are three “phases” of CML. They are defined by the number of immature blasts (white blood cells) involved.
- Chronic phase, which is the most common, is characterized by fewer than 10 percent blasts in the blood. This phase is typically managed with drugs that target the BCR-ABL1 protein; the disease can remain in this phase for years.
- Accelerated phase is characterized by up to 30 percent blasts in the blood. It is often managed with drug treatment, although your child’s doctor may recommend a stem cell transplant if there is no improvement.
- Blast phase, which involves more than 30 percent blasts in the blood, is treated more aggressively, often with chemotherapy and a bone marrow transplant.
Treatment with stem cell transplant (also called a bone marrow transplant) involves taking healthy stem cells from a donor and transplanting them into your child’s bloodstream. The healthy stem cells make their way to the child’s bone marrow and start producing normal white blood cells, red blood cells and platelets.
If your child needs a bone marrow transplant, family members may be tested to see who might be a suitable bone marrow donor.
Stem cell transplants are challenging procedures for patients, but can provide long-term cure. Stem cell transplant specialists at Cincinnati Children’s use the latest proven approaches to improve the effectiveness and safety of stem cell transplantation. Stem cell transplant most often succeeds, but not always. Sometimes the CML stem cells may survive and re-emerge. A child may receive TKI therapy after stem cell transplant to lower the risk of future relapse.