Treating Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia (CML) is due to a specific chromosomal change — a translocation — or a switching of material between chromosomes 9 and 22, creating the so-called Philadelphia chromosome.

This change results in a signal-transducing molecule, which continuously sends a signal for white blood cells to grow and divide. Primitive white blood cells (myelo-blasts) grow out of control as a result.

With early intervention, the outcome for complete remission is hopeful in most cases for patients with chronic myeloid leukemia.

In some cases, without effective treatment, CML may convert to a more aggressive form of acute leukemia.

Remission Is the Goal

Treatment goals for most types of leukemia are to induce remission. Remission is a decrease or disappearance of the signs or symptoms of your leukemia.

Degrees of Remission

Hematologic remission

  • Return to normal blood counts
  • Generally within first 3 months of therapy

Karotypic remission

  • Requires bone marrow biopsy
  • 0 out of 20 cells contain Philadelphia chromosome

Molecular remission

  • Polymerase Chain Reaction (PCR)-based study
  • 1 in 10,000 cells (0.1 percent) contain Philadelphia chromosome

At Scott & White, treatment goals for CML are to achieve a molecular remission:

  • Considered a good outcome
  • Not expected to convert to acute leukemia
  • Pushes out natural history of the disease

At Scott & White, we explore every treatment option. In many cases, your leukemia treatment will include a combination of approaches.

Treatment options for CML include:

  • Targeted Therapy
  • Allogeneic Blood Stem-Cell Transplantation
  • Chemotherapy
  • Surgery
  • Radiation Therapy

Your physician will discuss which treatment options are best for you.

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Targeted Therapy

CML is the poster child for targeted therapies. Treatment is not done in conjunction with chemo. We talk about chronic myelogenous leukemia now in the Gleevec® era. There’s really been a huge paradigm shift. It’s been a model that people are now using to try to develop targeted therapies for other diseases as well.

Mark H. Holguin, MD, Hematology/Oncology; Chief – Section of Hematology

The primary way of treating CML is with a targeted therapy that blocks your Philadelphia chromosome from sending the signal to make more white blood cells. Scott & White offers several FDA-approved drug therapies that work very well in controlling CML. Your physician will discuss which drug-therapy protocol is best for you.

These targeted therapies in many cases result in a karotypic remission in the 80 to 90 percent range.

Find out more about targeted therapies

Allogeneic Blood Stem-Cell Transplant

In some cases, your physician may suggest you consider receiving blood stem-cell transplant.

Blood stem-cell transplant is a procedure replacing your leukemic bone marrow with healthy bone marrow stem cells. An allogeneic transplant (ALLO) involves removing bone marrow from a matched donor. (Allo means “other.”)

Scott & White does not offer allogeneic blood stem-cell transplants. All allogeneic blood stem-cell transplants are referred to one of our accredited partners in the state.

Find out more about allogeneic blood stem-cell transplant

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Surgery

Splenectomy

A splenectomy is the surgical removal of your spleen. In some cases, your physician team may recommend a splenectomy if your spleen becomes enlarged due to your CLL. Because your spleen contains large groups of lymph nodes, it may become painful and lower your blood cell counts.

A splenectomy may help improve your blood cell counts, but it may also increase your risk of infection.

Radiation Therapy

Radiation therapy uses high-powered X-rays, seeds or radioactive material to shrink or destroy your tumor.

Radiation therapy is infrequently used to treat leukemia. However, in some cases, your physician team may recommend concurrent radiation therapy in addition to other treatments for your leukemia.

Find out more about radiation therapy for your leukemia

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