What types of treatment are used?

The treatment of chronic myeloid leukaemia will depend on the phase of the illness.

In the chronic phase the aim of treatment is usually to control the condition, often for several years and to prevent symptoms of the disease so that your quality of life is good. There are a number of effective treatments and your doctor will discuss with you which is most appropriate to your situation.

Treatment can be with a drug called interferon alpha, which is given as a small injection under the skin; a drug called imatinib (Glivec); or chemotherapy tablets known as hydroxyurea. Sometimes a combination of interferon and chemotherapy may be used. A research trial is being carried out to assess the effectiveness of giving a chemotherapy drug (arabinoside) as well as interferon. Arabinoside is also known as Ara-C. Trials are also assessing the effectiveness of using interferon in combination with imatinib.

A donor bone marrow or stem cell transplant may be a suitable treatment for some patients and can cure the leukaemia for some people. This is more likely to be possible in younger patients who have a brother or sister whose bone marrow is a close match to their own.

Your doctor will discuss the possible treatment options with you and the benefits and disadvantages of each. When the leukaemia becomes more advanced (accelerated and blast phase) treatment is usually a combination of chemotherapy drugs, given by injection into a vein (intravenously).

Other treatments may be given to deal with conditions which may arise as a result of CML. When you are first diagnosed your white blood cell count may be very high. This can occasionally lead to a clogging-up of blood vessels which may cause some physical problems. However, it can be treated by a process of removing the extra white cells – leukopheresis – (using a machine called a cell separator).

If you have myelofibrosis (scarring of the bone marrow) it is unfortunately not possible to reverse this process, but regular blood transfusions, for anaemia, and antibiotics can keep you reasonably well for a long time.

How does your doctor plan your treatment?

Your doctor will plan your treatment by taking into consideration a number of factors, including the stage of leukaemia and your general health.

You may be asked if you would be willing to take part in a clinical trial of a new treatment for CML.

If you have any questions about your own treatment, don’t be afraid to ask your doctor or nurse. It often helps to make a list of questions for your doctor and to take a close friend or relative with you. They can remind you of questions you wanted to ask, and afterwards help you remember what the doctor said.

Giving your consent

Before you have any treatment your doctor will explain the aims of the treatment to you and you may be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you sign the form you should have been given full information about:

• the type and extent of the treatment you are advised to have
• the advantages and disadvantages of the treatment
• any possible alternative treatments that may be available
• any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.

Patients often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you and the staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment, if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment, and the staff can explain what may happen if you do not have it. It is essential to tell a doctor, or the nurse in charge, immediately so that he or she can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.