What to Expect from CML Treatment: An Overview
Checking for a Response
While you're taking TKIs, your doctor will monitor you carefully to make sure your body is responding to the drug.
To track progress, you will visit your doctor regularly for tests of blood and bone marrow, including:
Complete blood count. A blood sample is tested to check the numbers of white blood cells, red blood cells, and platelets.
Blood cell exam. Cells are stained and examined under a microscope to look for the percentage of immature blood cells.
Cytogenetic analysis. Bone marrow cells are looked at under a microscope to check for the abnormal Philadelphia chromosome.
Polymerase chain reaction (PCR). DNA from blood or bone marrow cells is examined to look for the BCR-ABL gene.
When doctors run these tests, they're looking for certain types of responses in the cells. The goal of treatment is to have the following responses:
- No abnormal white blood cells and normal blood cell counts. This is called a complete hematologic response.
- No blood or bone marrow cells containing the Philadelphia chromosome. This is called a complete cytogenetic response.
- No sign of BCR-ABL in your blood. This is called a complete molecular response.
You'll likely visit your doctor for tests on the following schedule:
- During the first three months of treatment, you'll have a complete round of blood tests done every two weeks.
- After the third month, you'll have cytogenetic testing done at least once every six months until you achieve a complete cytogenetic response. You will also have a follow up bone marrow study at three months.
- Once you have achieved a complete cytogenetic and molecular response, you'll have a PCR test done every six months, and cytogenetic testing once every 12 months.
There is an excellent chance that you will have a complete cytogenetic response, or remission, while you're taking a TKI. That's great news, because it means that the abnormal gene is no longer in your cells. It doesn't mean that you're cured, though.
What if CML Treatment Doesn't Work?
Gleevec works well for most people, but no treatment is perfect. You might have to stop taking the drug because:
- You're having side effects that you can't tolerate.
- The medication isn't controlling your CML.
- The drug stopped working.
Other CML treatment options include:
- Patients with CML that are resistant to Gleevec treatment may also be treated with a different TKI, such as Bosulif, Iclusig, Sprycel, or Tasigna.
- Chemotherapy kills abnormal cells throughout the body. However, chemotherapy isn't as effective for CML as it is for other types of leukemia. Only a small percentage of people can achieve a remission with chemotherapy, and it's usually short-lived. Chemotherapy is usually reserved for patients in blast crisis. The chemotherapy used is similar to that used for acute leukemia.
- Immunotherapy with a daily injection of a drug such as interferon. This treatment stimulates your body's own immune system to destroy the cancer.