Illustration of CML
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What's Happening in Your Blood?

CML affects your bone marrow, where blood cells are made. When you have this cancer, it makes a lot of abnormal white blood cells that don't fight infections well. As they build up in your body, they crowd out your healthy blood cells.

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Illustration of the Philadelphia Chromosome
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The Role of Chromosomes

They carry genes, which tell your cells what to do. When you have CML, pieces of chromosomes 9 and 22 break and switch places. The result is a version of chromosome 22 that's called the "Philadelphia" chromosome. It carries a new gene called bcr-abl, which sets off a process that creates abnormal white blood cells.

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Testing Blood for CML
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Chronic Phase

You probably won't have any symptoms during this period. Only a small number of abnormal white blood cells are in your blood and bone marrow, so your body is still able to fight infections. Even though you might not feel sick now, it's important to get treated so your disease doesn't get worse.

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Fever as a result of CML
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Accelerated Phase

When you're in this stage, the number of your abnormal blood cells has increased. You may feel tired, lose weight, get short of breath, or have a fever.

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Normal and Abnormal White Blood Cell Counts
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Blast Phase

The number of abnormal blood cells in your bone marrow and blood is now high. At the same time, you have fewer healthy red and white blood cells and platelets. You're more likely to get infections, and you may have anemia or bleeding that's hard to control. Without treatment, this stage can be life-threatening.

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CML Medication
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Targeting the Abnormal Protein

You may first be treated in the chronic phase with drugs called tyrosine kinase inhibitors (TKIs). They kill off CML blood cells by blocking the protein made by the abnormal gene bcr-abl. You may have side effects like rashes and swollen skin, nausea, muscle cramps, and diarrhea. When TKIs can't control the disease, there are other treatment options.

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CML Patient Undergoing Bone Marrow Transplant
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Stem Cell Transplant

It's an option for some people who don't respond to TKIs or other therapies. First, you get high doses of chemotherapy drugs to kill blood-forming stem cells in your bone marrow. Then, you receive stem cells from a matched donor. These will form new, healthy blood cells. A stem cell transplant has the best chance to cure CML. But newer treatments that target bcr-abl can also help many people get into remission.

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Woman Recovering from Stem Cell Transplantcml
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Can I Get a Stem Cell Transplant?

The procedure tends to work best for people who are:

  • Younger rather than older
  • In the chronic phase
  • In overall good health

The high chemotherapy doses used for transplants have risks. Side effects can include infections and anemia, but as you recover, most will go away. There is a risk, though, that it will permanently affect your ability to have children.

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Biological Interferon Treatment for CML
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Other CML Treatment Options

If TKIs aren't working, other choices include:

  • Chemotherapy drugs taken by mouth to kill abnormal cells throughout your body, such as the meds hydroxyurea or busulfan
  • Biological drugs, like interferon, that push your immune system to fight off the cancer
  • New, experimental CML treatments you can try if you join a clinical trial
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Running Tests for CML
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When you have CML, you'll see your doctor at least every few months to learn how well your treatment is working and look for side effects. They may recommend that you get:

  • Complete blood count and bone marrow tests to measure red and white blood cells and platelets
  • Fluorescent in situ hybridization (FISH) test to see how many cells contain the Philadelphia chromosome
  • Polymerase chain reaction (PCR) test to look for the bcr-abl gene
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Doctor Answering Questions About CML Treatment
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Questions About Your Treatment

When you see your doctor, ask them:

  • What CML phase am I in?
  • What are my treatment options and what side effects might I get?
  • Should I get a second opinion?
  • Can I join a clinical trial that's testing an experimental therapy?
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Group of CML Patients in Support Group
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Be Active in Your Treatment

Take a few simple steps to make sure you get the help you need:

  • Go to all of your checkups so your doctor can change your therapy if it's not working.
  • Tell them about any side effects you have.
  • Get some emotional support from friends, family members, or your medical team.
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Testing Blood for CML Treatment Progress
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Signs Your Treatment Is Working

Your doctor will look for progress in these areas:

  • An improvement in the number of healthy white blood cells and platelets
  • Fewer cells with the Philadelphia chromosome in your blood and bone marrow
  • Fewer cells with the bcr-abl cancer gene
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Patient in CML Remission With Doctor
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Am I in Remission?

Your doctor will say your disease is no longer active when:

  • Your blood cell count is normal
  • No cells with the Philadelphia chromosome can be found in your blood or bone marrow
  • None of the abnormal gene can be found in your blood

Being in remission isn't the same as being cured. The cancer can return.

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CML Patient Suffering From Relapse
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Watch for Symptoms of a Relapse

CML can come back even after it's been successfully treated. Warning signs of a relapse include fatigue or weakness, weight loss, fever, night sweats, bone pain, swelling or pain on the left side (a symptom of an enlarged spleen), and a feeling of fullness in the belly. Call your doctor if you notice any of these red flags.

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SEM Image of CML Blood Cells
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Why Isn't My Treatment Working?

CML therapy works well for most people, but not everyone. Reasons why your treatment might stop helping include that the cancer cells change (mutate) or not enough medication gets into your bloodstream. If your treatment isn't effective, your doctor may adjust your drug doses or switch you to another therapy.

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Sources | Medically Reviewed on 01/22/2020 Reviewed by Sabrina Felson, MD on January 22, 2020

1)   Joaquin Carrillo-Farga / Photo Researchers, Inc.
2)   John Todd/WebMD
3)   Lester Lefkowitz/Photographer’s Choice
4)   Bartomeu Amenqual/Age Fotostock
5)   Eric V. Grave / Photo Researchers, Inc., ISM/Phototake
6)   Tetra Images
7)   Rajua, Phanie/Photo Researchers Inc
8)   Image Source
9)   Jean Claude Revy, ISM/Phototake
10)  BSIP/Photo Researchers Inc
11)  Stockbyte
12)  Manchan/Digital Vision
13)  David Papas/Uppercut Images
14)  LWA, Dann Tardif/Blend Images
15)  Steve Pomberg/WebMD
16)  SPL/Photo Researchers Inc


Abeloff, M. Abeloff's Clinical Oncology, 4th ed., Churchill Livingstone, 2008.

American Cancer Society.

CML Alliance.

Goldman, L. Cecil Medicine, 23rd ed. Saunders Elsevier, 2007.

MD Anderson Cancer Center.

National Cancer Institute.

The Leukemia & Lymphoma Society.

Reviewed by Sabrina Felson, MD on January 22, 2020

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.