Chronic Granulocytic Leukemia (CGL)

Chronic granulocytic leukemia (CGL) is an older name for chronic myeloid leukemia (CML), a blood cancer that starts from the bone marrow cells that make white blood cells, especially granulocytes. In most people, the leukemia cells carry a special genetic change called the Philadelphia chromosome. This chromosome creates the BCR-ABL1 fusion gene, which makes an abnormal enzyme (tyrosine kinase) that tells the cells to grow too fast and not die when they should. Over time this causes very high white blood cell counts, a big spleen, tiredness, weight loss, night sweats, and sometimes bleeding or infections if the marrow stops working properly. CML usually has a chronic phase, then may move to an accelerated and finally a blast phase if it is not controlled. Modern targeted medicines called tyrosine kinase inhibitors (TKIs) can control this disease for many people for many years, often with just one pill a day.

Chronic granulocytic leukemia is an older name for a blood cancer that doctors now usually call chronic myeloid leukemia (CML) or chronic myelogenous leukemia. It starts in the bone marrow, where blood cells are made. In this disease, too many white blood cells called granulocytes (neutrophils, eosinophils, basophils) grow and do not die when they should. These abnormal cells crowd out normal blood cells in the bone marrow and blood. CML is a clonal stem cell disease, which means it comes from one damaged stem cell that keeps making many copies of itself.

Most people with CML have a special chromosome change called the Philadelphia chromosome. This change joins two genes, BCR and ABL1, into one fusion gene called BCR::ABL1. This fusion gene makes an abnormal tyrosine kinase protein that is “always on” and tells cells to grow and divide too much. This constant signal is the main biological cause of chronic granulocytic leukemia.

Other names

Doctors and books may use several different names for the same disease. These names are helpful to know because you may see all of them in reports or online:

• Chronic granulocytic leukemia (CGL)

• Chronic myeloid leukemia (CML)

• Chronic myelogenous leukemia

• Philadelphia chromosome–positive CML

• BCR::ABL1-positive myeloproliferative neoplasm

All of these terms refer to a long-lasting (chronic) blood cancer in which the myeloid cell line (especially granulocytes) grows too much and is almost always linked to the BCR::ABL1 fusion gene.

Types

Doctors usually divide chronic granulocytic leukemia into phases based on how many blast (very immature) cells are present and how aggressive the disease is. These phases help guide treatment and show how serious the disease is.

1. Chronic phase
   This is the earliest and most common phase when CML is found. There are many mature granulocytes in the blood and bone marrow, but blast cells are still low in number. Many people have few or no symptoms, and the disease grows slowly. Most patients are diagnosed in this phase, often after a routine blood test shows high white blood cells.

2. Accelerated phase
   In this phase, the disease is changing and becoming more aggressive. Blast cells and basophils increase, blood counts are harder to control, and symptoms such as fatigue, weight loss, and spleen enlargement may get worse. Doctors see more genetic changes in the leukemia cells. Without good control, this phase can move into blast crisis.

3. Blast crisis (blast phase)
   Blast crisis is the most severe phase. Many blast cells appear in blood and bone marrow, and the disease behaves like an acute leukemia. People are often very unwell, with severe symptoms, low normal blood cells, and a high risk of infections and bleeding. Treatment becomes more difficult, and urgent specialist care is needed.

Causes and risk factors

For chronic granulocytic leukemia, the main cause is the BCR::ABL1 gene fusion, which happens when parts of chromosomes 9 and 22 swap places to form the Philadelphia chromosome. In most people, doctors cannot say exactly why this swap happened. However, research has found several risk factors that may increase the chance of CML or leukemia in general. Remember, risk factors do not mean a person will definitely get the disease; they only change the chance.

1. BCR::ABL1 fusion (Philadelphia chromosome)
   This chromosomal translocation t(9;22) creates the BCR::ABL1 fusion gene. It causes the abnormal tyrosine kinase activity that drives chronic granulocytic leukemia. Without this fusion or a very similar one, classic CML does not usually develop. It is a random change in one stem cell, not something a person is born with.

2. High-dose ionizing radiation
   People exposed to very high doses of ionizing radiation, such as survivors of atomic bomb blasts or major nuclear accidents, have an increased risk of CML. Radiation can damage DNA in bone marrow stem cells and make chromosomal breaks that may lead to the BCR::ABL1 fusion.

3. Radiation therapy for other cancers
   Strong radiation used to treat other cancers can also damage bone marrow DNA. This treatment can slightly raise the risk of later developing leukemia, including CML, though the absolute risk is still low and must be balanced against the benefits of curing the first cancer.

4. Exposure to benzene
   Benzene is a chemical used in some industries and is also found in gasoline and cigarette smoke. Long-term exposure to benzene is a known risk factor for leukemia, especially AML, and may also contribute to CML risk by damaging marrow stem cells and chromosomes.

5. Previous chemotherapy (especially alkylating agents)
   Some chemotherapy drugs can cause DNA damage in bone marrow cells. Years after treatment, this can sometimes lead to therapy-related leukemias. Many reports involve AML or MDS, but prior chemotherapy is also considered a possible risk for CML in some patients.

6. Cigarette smoking
   Smoking exposes the body to many cancer-causing chemicals, including benzene. Smoking is clearly linked to AML and other leukemias, and some studies suggest it may also increase risk of CML, although the link is weaker. Avoiding smoking lowers overall leukemia risk.

7. Male sex
   CML is diagnosed slightly more often in men than in women. The exact reason is not clear. It may involve hormonal differences, different exposure to chemicals, or other unknown factors.

8. Older age
   The risk of chronic granulocytic leukemia increases with age, and the typical age at diagnosis is around 60–65 years. Over time, more random DNA changes build up in stem cells, which may explain why the disease is more common in older adults.

9. Family history of leukemia (very rare factor)
   Most people with CML do not have a family history. However, a small number of families show more than one case of leukemia, suggesting that inherited genes may slightly increase the chance of bone marrow cancers in some people.

10. Other genetic conditions affecting DNA repair
    Some inherited conditions that weaken DNA repair or stability can raise leukemia risk in general. These include disorders like Fanconi anemia or other rare syndromes. They are not specific to CML but may contribute to a higher background risk of marrow cancers.

11. Long-term exposure to industrial chemicals
    Working in places where solvents, pesticides, or petroleum products are present may slightly increase leukemia risk. The evidence is strongest for benzene, but other chemicals may also damage marrow DNA over time.

12. Previous blood or bone marrow disorders
    People with other myeloproliferative or myelodysplastic disorders already have unstable marrow cells and abnormal blood production. In rare cases, extra changes can occur and result in a CML-like picture with BCR::ABL1.

13. Obesity and metabolic factors
    Being overweight has been linked to increased risk of several cancers, including leukemia in some studies. Extra fat tissue can change hormone levels and create chronic inflammation, which may make DNA damage more likely in bone marrow cells.

14. Immune system problems
    A weak or disordered immune system cannot remove abnormal cells as well as a healthy one. People with certain immune deficiencies or long-term immune-suppressing drugs (after transplant or for autoimmune disease) may have a higher risk of blood cancers, though this is better proven for lymphomas and some leukemias than for CML.

15. Long-term low-level radiation exposure
    Repeated low-level exposure, such as certain occupational exposures, may add a small extra risk over many years. The effect is much weaker than very high-dose exposure, but careful safety rules aim to keep doses as low as possible.

16. Air pollution with traffic exhaust
    Vehicle exhaust contains benzene and other chemicals that can damage DNA. Studies on overall leukemia risk suggest that living or working in highly polluted areas may slightly increase the chance of blood cancers, though the link to CML alone is not strong.

17. Occupational exposure in refineries and chemical plants
    People working in oil refineries, rubber factories, or chemical plants may be exposed to benzene and related solvents. Without good protection, this can increase leukemia risk. Modern safety rules are designed to reduce this danger.

18. Previous stem cell damage from viral infections (theoretical)
    Some viruses can disturb the bone marrow or immune system, but a clear virus cause for CML has not been proven. Experts sometimes discuss viruses as a possible but unconfirmed factor in leukemia development.

19. Random genetic chance
    For most individuals with CML, no clear exposure or risk factor is found. The BCR::ABL1 change seems to happen by chance in one stem cell. This means that a person can develop chronic granulocytic leukemia even if they have no known risk factors at all.

20. Combined small effects of many factors
    Often several small things work together: age, slight chemical exposures, personal genetics, and lifestyle may all contribute. None of them alone may be enough, but together they can raise the chance that a marrow stem cell will acquire the Philadelphia chromosome.

Symptoms and signs

Many people with chronic granulocytic leukemia have no symptoms at first. The disease is often found when a routine blood test shows high white blood cells. If symptoms appear, they usually develop slowly over months. They are often caused by too many abnormal cells and not enough healthy cells, plus an enlarged spleen.

1. Tiredness and weakness (fatigue)
   Fatigue is very common. The body may not make enough red blood cells, leading to anemia. With fewer red cells, the blood carries less oxygen, so people feel tired, weak, and easily exhausted even after small activities.

2. Shortness of breath
   Because of anemia and the extra work of moving thick blood full of cells, people can feel breathless when climbing stairs or doing simple tasks. This symptom may appear together with paleness and fast heartbeat.

3. Pale skin (pallor)
   Low red blood cell levels make the skin and inside of the eyelids look pale. This is a visible sign of anemia caused by crowding of the bone marrow with leukemia cells.

4. Frequent infections
   Although white blood cells are high, many of them are abnormal and do not work properly. This weakens the immune system, so infections such as repeated colds, chest infections, or skin infections can happen more often and last longer.

5. Fever and night sweats
   Ongoing low-grade fever and sweating at night are common symptoms. They can be caused by infections or by inflammatory chemicals released by leukemia cells. People may wake up with wet clothes or sheets.

6. Unexplained weight loss
   People may lose weight without trying. This can happen because the body uses a lot of energy to make and handle extra leukemia cells, and because inflammatory signals reduce appetite and change how the body uses food.

7. Loss of appetite and early fullness
   The spleen often gets bigger and presses on the stomach. This makes a person feel full quickly, even after only a small meal, and they may lose interest in food.

8. Abdominal discomfort or pain (especially on the left side)
   An enlarged spleen sits under the left ribs. It can cause a dull ache or feeling of pressure there. In severe cases it may cause pain that radiates to the shoulder or back.

9. Easy bruising and bleeding
   Platelets may become low or not work well. This can lead to nosebleeds, bleeding gums, heavy periods, or bruises appearing after small bumps or even without clear injury.

10. Bone or joint pain
    The bone marrow can become packed with leukemia cells. This pressure, and the rapid turnover of cells, may cause aching or sharp pains in bones or joints, especially at night or during activity.

11. General feeling of being unwell (malaise)
    Many people just feel “not right,” with low energy, poor sleep, and vague discomfort. This is a common but non-specific symptom of many blood cancers, including chronic granulocytic leukemia.

12. Headaches and dizziness
    Very high white cell counts can make the blood thicker, which can reduce blood flow to the brain. This may cause headaches, dizziness, blurred vision, or ringing in the ears, especially when counts are extremely high.

13. Swollen lymph nodes
    Some people may notice lumps in the neck, armpits, or groin. These are enlarged lymph nodes full of abnormal or reactive cells. This sign is more common in advanced phases or when there are mixed features with other leukemias.

14. Gout-like joint swelling or kidney problems
    When many leukemia cells break down, they release uric acid. High uric acid levels can cause painful swollen joints (like gout) or kidney stones and kidney strain.

15. Symptoms of blast crisis (severe phase)
    In blast crisis, symptoms become more intense. There may be extreme fatigue, serious infections, heavy bleeding, bone pain, and sometimes symptoms similar to acute leukemia or even strokes due to very thick blood. This phase is a medical emergency.

Diagnostic tests

To diagnose chronic granulocytic leukemia and understand its phase, doctors use a group of tests. These tests look at the body, the blood, the bone marrow, and the chromosomes and genes in the leukemia cells. No single test is enough; they work together to give a full picture.

Physical exam tests

1. Full physical examination and medical history
   The doctor asks about symptoms such as fatigue, weight loss, infections, night sweats, and bleeding, and checks vital signs like temperature, pulse, and blood pressure. A careful history can suggest a chronic blood problem and guide which tests to do next.

2. Examination of spleen and liver size
   The doctor gently presses (palpates) and taps (percusses) the abdomen to feel if the spleen or liver is enlarged. A big spleen is a common sign in chronic granulocytic leukemia and can help distinguish it from some other conditions.

3. Check of lymph nodes and skin
   The doctor feels for enlarged lymph nodes in the neck, armpits, and groin, and looks at the skin and gums for bruises, bleeding spots, or pallor. These findings can show low platelets, anemia, or spread of abnormal cells.

4. General performance status assessment
   The doctor assesses how well the person can do daily activities, walk, climb stairs, and care for themselves. This “performance status” is important for planning treatment and judging how advanced the disease might be.

Manual / bedside tests

5. Manual differential count on peripheral blood smear
   A lab worker or doctor looks at a stained blood smear under the microscope and manually counts different types of white cells (neutrophils, eosinophils, basophils, blasts). In CML there are many granulocytes at different stages of maturity and often increased basophils. This manual count supports the diagnosis.

6. Manual spleen measurement (by palpation in centimeters)
   Doctors often record how many centimeters below the left costal margin (rib edge) the spleen can be felt. Tracking this simple bedside measure over time helps monitor response to treatment because the spleen usually shrinks as the leukemia is controlled.

7. Bedside assessment of bleeding (gum and skin check)
   Checking for oozing from the gums, petechiae (small red spots), and easy bruising after a gentle pressure test helps the doctor guess whether platelets are low or not working well. This supports lab findings about clotting and platelet counts.

Laboratory and pathological tests

8. Complete blood count (CBC)
   A CBC measures numbers of white blood cells, red blood cells, and platelets. In chronic granulocytic leukemia, the white cell count is usually very high, sometimes in the hundreds of thousands, often with mild anemia and sometimes abnormal platelets. The CBC is often the first clue.

9. Peripheral blood smear (microscopy)
   Looking at the shape and maturity of cells on a blood smear shows a full spectrum of myeloid cells, from blasts to mature neutrophils, and usually increased basophils and eosinophils. This pattern helps distinguish CML from a simple infection (leukemoid reaction).

10. Bone marrow aspiration
    A thin needle is inserted into the back of the hip bone to suck out liquid marrow. The cells are examined under the microscope to see how crowded and abnormal they are and to count blast cells. This test helps confirm the diagnosis and phase.

11. Bone marrow biopsy (core)
    A small core of bone is taken to see the structure of the marrow. It shows how full the marrow is with myeloid cells and whether there is scarring or other changes. Together with aspiration, this gives a detailed picture of marrow health.

12. Conventional cytogenetics (karyotyping)
    Chromosome banding analysis looks at the number and structure of chromosomes in dividing marrow cells. In CML, it can reveal the Philadelphia chromosome t(9;22) and any additional chromosomal changes that may appear in advanced disease.

13. Fluorescence in situ hybridization (FISH) for BCR::ABL1
    FISH uses glowing probes to detect the BCR::ABL1 fusion directly in cells. It is more sensitive than standard karyotyping and can find the fusion even if only a small number of cells carry it or if the translocation is complex.

14. Qualitative RT-PCR for BCR::ABL1
    Reverse transcriptase PCR detects whether the BCR::ABL1 fusion transcript is present or not. This is highly sensitive and can confirm the diagnosis when cytogenetic results are unclear. It can also identify which transcript type (for example p210) is present.

15. Quantitative RT-PCR (qPCR) for BCR::ABL1
    qPCR measures exactly how much BCR::ABL1 transcript is in the blood or marrow and reports it on an international scale. This test is crucial for monitoring how well treatment is working over time and for checking deep molecular responses.

16. Comprehensive metabolic panel and uric acid
    Blood chemistry tests measure kidney and liver function, electrolytes, and uric acid. High uric acid suggests rapid cell turnover.

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Non-pharmacological treatments (therapies and other supports)

1. Patient education and shared decision-making
Education means the doctor or nurse explains in simple language what CML is, what the phases are, why TKIs are needed, how to take them, and what blood tests and bone marrow tests are done. Good education helps you understand the goal (deep molecular response, prevention of progression) and the importance of taking the tablet every day. When patients understand their disease, they usually take their medicine more regularly and come to follow-up visits on time, which is strongly linked to better long-term survival in CML.

2. Regular exercise and physical rehabilitation
Gentle to moderate physical activity such as walking, cycling, or light strength training can reduce cancer-related fatigue, improve mood, sleep, and heart fitness in people with leukemia and other blood cancers. Exercise programs supervised by physiotherapists or exercise specialists have been shown to lower tiredness, anxiety, and depression and to improve muscle strength and daily function, even during chemotherapy or targeted therapy. The usual idea is to aim for regular sessions each week, adjusted to how the patient feels and what the doctor allows.

3. Psychological counseling and psycho-oncology support
A diagnosis of CML can cause fear, sadness, anger, and sleep problems. Professional psychological support (for example cognitive–behavioural therapy, support groups, or family-based counseling) has been shown to reduce anxiety and depression and to improve quality of life in people with leukemia. Screening for distress and offering early psychological help can make it easier for patients to cope with long-term treatment and frequent hospital visits.

4. Social work, financial and practical support
Long-term treatment may affect school, work, and family life. Social workers can help with transport to hospital, financial aid programs, work or school accommodations, and insurance questions. Studies show that better social support is linked with better coping, less stress, and improved quality of life in leukemia patients, because they feel less alone and more able to manage practical problems.

5. Infection-prevention habits
CML itself and its treatments can sometimes lower white cell function. Simple habits like frequent handwashing, avoiding close contact with people who have flu-like illness, and careful food safety (well-cooked meats, washing fruits and vegetables, avoiding unpasteurised products) reduce the risk of serious infections. These steps are especially important after intensive treatments like stem cell transplant, when the immune system is weak.

6. Healthy sleep and fatigue management
Cancer fatigue is very common in leukemia. Non-drug methods include keeping a regular sleep schedule, short planned rests instead of long daytime naps, light exercise, energy-saving strategies (sitting to do tasks, planning the day), and relaxation breathing. These approaches, combined with treating medical causes like anemia or thyroid problems, can lessen fatigue and improve day-time energy.

7. Nutrition counseling
Dietitians help patients plan meals during and after CML treatment. The aim is to keep weight stable, protect muscle mass, and support the immune system. Guidance generally includes enough protein, whole grains, fruits, vegetables, healthy fats, and safe food-handling rules, while adjusting fiber and seasoning if nausea or diarrhea occur from medicines. Good nutrition supports recovery from infections and improves overall strength.

8. Smoking cessation and alcohol moderation
Stopping smoking and limiting alcohol are important because they reduce extra strain on the heart, lungs, and liver, organs that can already be stressed by TKIs or other cancer treatments. Non-drug methods such as counseling programs, peer support, and behaviour change techniques can help people quit or cut down, which may reduce future cancer and heart disease risks.

9. Fertility and pregnancy counseling
Some TKIs and other CML treatments can affect pregnancy or sperm and egg quality. Non-pharmacological support includes early counseling about fertility preservation (such as sperm banking or egg/embryo freezing) and planning the safest time for pregnancy, which must always be coordinated with the hematologist and an obstetrician who knows about high-risk pregnancies. This helps patients make informed choices about family planning while staying safe.

10. Spiritual, cultural, and peer-support programs
For many patients, spiritual care, faith-based support, or community and peer groups give meaning and comfort during long treatment. Support groups (in person or online) allow people with CML to share experiences about symptoms, daily life, and coping. Research in cancer care shows that such support can improve emotional well-being and help with treatment adherence.

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Drug treatments

Note: Doses and schedules for these medicines are complex and must be chosen and adjusted only by a hematologist. Here we describe them in general terms based mainly on FDA labeling and expert guidelines, without detailed prescribing instructions.

1. Imatinib (Gleevec)
Imatinib is the first TKI developed for CML and changed CGL from a usually fatal disease into a chronic, often well-controlled condition. It blocks the BCR-ABL1 tyrosine kinase so that the abnormal signal telling leukemic cells to divide is turned down. Imatinib is taken by mouth once daily with food. It is used in newly diagnosed chronic-phase CML and in some advanced phases. Common side effects include nausea, fluid retention (such as ankle or eyelid swelling), muscle cramps, diarrhea, and mild bone-marrow suppression. Serious but less common effects can involve liver problems or heart issues, so regular blood tests and monitoring are needed.

2. Dasatinib (Sprycel)
Dasatinib is a second-generation TKI that blocks BCR-ABL1 and several other kinases. It is used for newly diagnosed CML and for patients who are resistant or intolerant to imatinib. It is taken once daily by mouth. Dasatinib can cause low blood counts, headache, diarrhea, skin rash, and fluid collections around the lungs (pleural effusion), so doctors monitor blood counts and breathing. Because it interacts with certain other medicines and stomach-acid drugs, the doctor carefully checks the full medication list.

3. Nilotinib (Tasigna)
Nilotinib is another second-generation TKI that binds tightly to BCR-ABL1 and is used in newly diagnosed CML or when imatinib fails. It is taken by mouth, usually twice a day on an empty stomach. Nilotinib can cause low blood counts, rash, itching, increased blood sugar, and changes on the heart’s electrical tracing (QT prolongation), so ECG and blood tests are done regularly. Because of the heart-rhythm risk, doctors avoid combining it with other drugs that affect the QT interval.

4. Bosutinib (Bosulif)
Bosutinib is a second-generation TKI that works against many imatinib-resistant BCR-ABL1 mutations. It is often used when other TKIs cannot be tolerated or have stopped working. It is taken orally once daily with food. The most common side effects are diarrhea, nausea, vomiting, liver-enzyme elevation, and low blood counts. With supportive care and dose changes, many patients can stay on treatment long term.

5. Ponatinib (Iclusig)
Ponatinib is a powerful TKI designed to work even when the leukemia carries the T315I mutation, which makes many other TKIs ineffective. It is taken orally once daily. Because ponatinib can increase the risk of serious blood-clot events, heart attack, stroke, and high blood pressure, it is usually reserved for patients with specific high-risk mutations or multiple TKI failures, and doctors use the lowest effective dose with very close heart and vessel monitoring. Common side effects also include rash, abdominal pain, and liver-test elevation.

6. Asciminib (Scemblix)
Asciminib is a newer “STAMP” inhibitor that targets the ABL myristoyl pocket in BCR-ABL1 instead of the ATP-binding site, which is different from older TKIs. It is used in adults with CML who have already tried at least two TKIs or who have the T315I mutation, and more recently it received accelerated approval also for newly diagnosed chronic-phase CML. It is taken by mouth at doses and schedules chosen by the hematologist. Common side effects include low blood counts, fatigue, nausea, headaches, and elevated pancreatic enzymes, so blood tests and symptom checks are important.

7. Hydroxyurea
Hydroxyurea is an older chemotherapy tablet that slows DNA production in rapidly dividing cells. In CGL/CML it is often used briefly at diagnosis to quickly lower very high white blood cell counts while TKI therapy is being started and arranged. It can cause low blood counts, mouth sores, darkening of the skin or nails, and sometimes stomach upset. Because TKIs work more precisely, hydroxyurea is usually not used as long-term main therapy anymore.

8. Interferon-alpha
Interferon-alpha is an immune signaling protein given as an injection. Before TKIs it was a major treatment for CML. Today it may be used in selected patients, such as some pregnant patients who cannot safely take TKIs, or people trying to deepen their molecular response. It works by slowing cell growth and boosting immune responses against leukemic cells. Common side effects include flu-like symptoms, depression, and thyroid changes, so monitoring of mood and thyroid function is important.

9. Omacetaxine mepesuccinate
Omacetaxine is an injectable medicine that blocks protein synthesis in leukemia cells. It can be used when multiple TKIs have failed. Treatment is given as under-the-skin injections in treatment cycles. It can cause strong bone-marrow suppression, infections, bleeding, and injection-site reactions, so it is usually used in specialised centers with experienced teams and close blood-count monitoring.

10. Supportive medicines (anti-emetics, antibiotics, growth factors)
Many other medicines are used around CML treatment to manage nausea, prevent or treat infections, correct anemia, or support white blood cells after very intensive therapy such as transplant. These include anti-nausea drugs, antibiotics or antivirals, and sometimes growth-factor injections. They do not treat CML directly but make the main treatment safer and more tolerable. All of them must be chosen by a doctor who knows the patient’s full history and all current medicines.

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Dietary molecular supplements (supportive, not a cure)

Very important: Supplements should never replace TKIs or other prescribed CML treatments. Always ask your hematologist before starting any vitamin, herbal, or “natural” product, because some can interact with TKIs or harm the liver.

1. Vitamin D
Vitamin D helps bone health, immune function, and muscle strength. Low vitamin D levels are common in many cancer patients. Correcting deficiency with doctor-advised doses may improve bone strength and general well-being, especially in people receiving long-term therapy and less sunlight. However, there is no proof that vitamin D alone can treat CML, so it is used only as supportive care and monitored to avoid high calcium levels.

2. Vitamin A and related compounds
Vitamin A and some related molecules (like all-trans retinoic acid) have shown some anti-leukemic actions in certain types of leukemia and were historically explored in CML. A classic nutrition paper noted potential benefit of vitamin A and D3 and a plant compound indirubin in CML, mainly in early, small studies. Today, high-dose vitamin A is not routine for CML because of toxicity and limited evidence, but a normal dietary intake through food may support general health.

3. Omega-3 fatty acids
Omega-3 fats from fish oil, flax, or algae may help reduce inflammation and support heart and blood-vessel health. This matters in CML because some TKIs can increase cardiovascular risk. Under medical supervision, omega-3 supplements or omega-3-rich foods may be used to support heart health, but they can also thin the blood slightly, so doctors need to know before surgery or if platelets are low.

4. Curcumin (from turmeric)
Curcumin has attracted attention for its anti-cancer potential. Laboratory studies in CML models show that curcumin can interfere with BCR-ABL1 and other signaling pathways, increase cancer cell death, and may act together with TKIs in resistant cell lines. At the moment this evidence is mainly in vitro (in cells and animals), not in large human trials, so curcumin should only be considered as a possible research-level supplement and not as a replacement for standard therapy.

5. Green tea catechins (EGCG)
Compounds in green tea, especially EGCG, can affect cancer-related signaling and antioxidant balance in lab models. Some people drink green tea or take extracts hoping for anti-cancer benefits. However, strong green-tea extracts have been linked to liver injury in some cases and may interact with drug-metabolising enzymes, which can change TKI levels. For this reason, any concentrated green-tea supplement must be discussed with the oncology team first.

6. Probiotics
Probiotics are “good bacteria” in capsules or fermented foods that may help gut health and immune function. In cancer patients, maintaining a healthy microbiome may support digestion, reduce some antibiotic-related diarrhea, and improve general well-being. However, in people with very low white blood cells or central lines, certain probiotic strains can very rarely cause infections, so they should only be used with medical approval.

7. Selenium
Selenium is a trace mineral needed for antioxidant enzymes. Some research in leukemia and other cancers suggests that adequate selenium status may support immune defence and control oxidative stress. Too much selenium can cause hair loss, nail changes, and nerve problems, so if supplementation is needed, it must be at modest doses under medical guidance, not in large uncontrolled amounts.

8. Zinc
Zinc is important for immune cells, wound healing, and taste. CML patients with poor appetite or repeated infections may be checked for zinc deficiency. Correcting low zinc levels with safe doses can help taste, appetite, and immunity. High-dose zinc, however, can upset copper balance and harm immunity, so it should not be taken without checking with the medical team.

9. B-vitamins (B12 and folate)
B12 and folate are needed for red blood cell production and DNA synthesis. Deficiency can worsen fatigue and anemia. Doctors sometimes test these levels in people with leukemia. If low, they can be replaced with tablets or injections. Normalising B12 and folate helps blood formation but does not treat CML itself, so it is used together with mainline CML therapy.

10. Plant-based antioxidant diet pattern
Rather than single pills, many guidelines stress an overall plant-based pattern rich in fruits, vegetables, whole grains, legumes, nuts, and seeds, with limited processed foods and sugars. This pattern supplies a broad mix of antioxidants, vitamins, minerals, and fiber that support heart health, gut health, and immune function during and after leukemia treatment. It is safer and better studied than many “mega-dose” supplements.

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Immunity-booster, regenerative, and stem-cell-related drugs

These medicines are only used under specialist supervision in very specific situations.

1. Hematopoietic growth factors (G-CSF, GM-CSF)
Growth-factor injections can stimulate bone marrow to make more white blood cells after very intensive treatments or stem cell transplant. In CML they are rarely used routinely, because they could stimulate both healthy and leukemic cells, but in some post-transplant or infection-related situations they help the immune system recover. They are given as short courses of injections and can cause bone pain and temporary high white cell counts.

2. Erythropoiesis-stimulating agents (ESAs)
ESAs are drugs that encourage bone marrow to produce red blood cells. They may be considered for severe treatment-related anemia in selected patients who cannot receive enough blood transfusions. They can increase the risk of blood clots, so doctors balance the benefits and risks very carefully and follow official guidelines.

3. Thrombopoietin receptor agonists
These medicines, used in some other blood disorders, can stimulate platelet production. They are not standard for CML itself but may be used off-label in very complex cases such as post-transplant thrombocytopenia inside clinical trials or specialist protocols, aiming to help platelets recover and reduce bleeding.

4. Immunoglobulin infusions (IVIG)
IVIG contains pooled antibodies from many donors. In leukemia patients with certain immune defects or frequent serious infections, IVIG can temporarily strengthen defense against bacteria and viruses. It is given through a vein over several hours. It does not treat the leukemia but can reduce infection risk while the immune system is very weak.

5. Drugs used around hematopoietic stem cell transplant
In patients who receive an allogeneic stem cell transplant (donor stem cells), several supportive medicines are used to help donor cells grow, prevent graft-versus-host disease, and reduce infections. These include immunosuppressants and antimicrobial drugs. They act together with the transplant to rebuild a healthy blood and immune system and to allow donor immune cells to attack remaining CML cells (graft-versus-leukemia effect).

6. Experimental regenerative or cell-based therapies
Research is exploring ways to target CML stem cells more precisely and to boost immune cells (like CAR-T or NK-cell therapies) so they can attack residual leukemia. These approaches are still mostly in clinical trials and are only available in specialised centers. They may be used for CML that does not respond to TKIs or transplant, and their goal is to regenerate a healthy blood system and remove resistant leukemic clones.

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Surgeries and procedures

1. Allogeneic hematopoietic stem cell transplant (HSCT)
Stem cell transplant is a major procedure in which diseased bone marrow is replaced with healthy stem cells from a matched donor. Before transplant, high-dose chemotherapy (sometimes with radiation) destroys most of the patient’s marrow. Then donor stem cells are infused through a vein, like a blood transfusion, and they travel to the bones to rebuild the blood system. This can potentially cure CML, but it carries significant risks, including infections, graft-versus-host disease, and organ damage, so it is usually reserved for advanced or TKI-resistant disease or for certain high-risk patients.

2. Leukapheresis
Leukapheresis is a procedure, not a drug, used when the white cell count is extremely high and causing symptoms like vision changes or breathing problems. Blood is taken from a vein, passed through a machine that removes excess white cells, and then returned. The procedure quickly lowers the white count while other treatments (like TKIs or chemotherapy) start to work. It improves blood flow and reduces immediate risk of complications.

3. Splenectomy
In some patients the spleen becomes very large and painful or causes very low platelets and red cells by over-destroying them. If medicines do not control this, surgeons may remove the spleen (splenectomy). Today this is much less common because TKIs usually shrink the spleen. After splenectomy patients need vaccines and careful infection prevention because the spleen is important in fighting certain bacteria.

4. Central venous catheter placement
For patients needing frequent blood tests, transfusions, or intensive therapy such as transplant, a surgeon or interventional radiologist may place a central venous catheter in a large vein in the chest. This is done under local or general anesthesia. The line makes treatment easier and less painful than repeated needle sticks, but it needs careful cleaning to prevent infections or clots.

5. Bone marrow biopsy and aspiration
Although not a “surgery” in the classic sense, bone marrow biopsy is an invasive procedure done repeatedly in CML. A doctor uses a needle to collect marrow from the hip bone. This sample is used to confirm the diagnosis, look for the Philadelphia chromosome/BCR-ABL1, check marrow response, and decide when disease is in chronic, accelerated, or blast phase. Local anesthesia and sometimes light sedation are used to control pain.

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Prevention and risk-reduction tips

Because CGL/CML is mainly linked to a genetic change in marrow cells, there is no known way to completely prevent it. But people living with CML can reduce complications and support long-term health by:

1. Taking TKIs exactly as prescribed and not skipping doses without medical advice.

2. Attending all follow-up visits and blood/molecular tests (like BCR-ABL monitoring) to catch problems early.

3. Avoiding smoking and limiting alcohol to protect the heart and liver.

4. Keeping an active lifestyle with safe, regular exercise to reduce fatigue and support heart health.

5. Following infection-prevention rules such as hand hygiene and food safety.

6. Keeping vaccines (such as flu and pneumonia) up to date if approved by the hematologist.

7. Maintaining a balanced, mostly plant-based diet with enough protein, fruits, vegetables, and whole grains.

8. Managing other illnesses like high blood pressure, diabetes, or high cholesterol, especially when taking TKIs that affect the heart and vessels.

9. Asking early for psychological and social support when feeling overwhelmed, instead of waiting until distress is severe.

10. Discussing any new supplement, herb, or over-the-counter medicine with the oncology team before using it.

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When to see a doctor urgently

A person with chronic granulocytic leukemia should contact their doctor or go to emergency care immediately if they have:

• Fever, chills, or signs of infection (such as burning when passing urine, new cough, shortness of breath), because low white cell function can make infections dangerous.

• Sudden bruising, nosebleeds, bleeding gums, or tiny red spots on the skin, which may mean platelets are very low.

• Strong chest pain, shortness of breath, sudden weakness on one side, trouble speaking, or severe headache, especially when on TKIs like ponatinib or nilotinib that can affect the heart and blood vessels.

• Sudden vision changes or confusion when the white count is very high, which can signal poor blood flow in small vessels.

• Rapidly growing spleen area pain (left upper belly), severe fullness after small meals, or sharp abdominal pain.

• Any strong new side effect after starting or changing a TKI, such as severe swelling, difficulty breathing, or yellowing of the eyes and skin.

For non-urgent issues like mild tiredness, mild nausea, or questions about work, school, travel, or vaccines, patients should still inform their hematology team at the next visit, so treatment can be adjusted safely.

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What to eat and what to avoid

What to eat more of
CML patients are usually encouraged to eat:

• Plenty of fruits and vegetables of many colours for vitamins, minerals, and antioxidants that support general and immune health.

• Whole grains like oats, brown rice, and whole-wheat bread to provide steady energy and fiber.

• Lean proteins such as beans, lentils, fish, eggs, poultry, or dairy to maintain muscles and repair tissues during treatment.

• Healthy fats from nuts, seeds, olive oil, and fatty fish to support heart and brain health.

• Plenty of fluids, mainly water, unless the doctor has set a limit, to help kidneys clear waste from dying cells and medicines.

What to limit or avoid

• Raw or undercooked meats, eggs, and unwashed fruits/vegetables, to lower infection risk, especially when immune function is low.

• Very processed foods and sugary drinks, which add calories without important nutrients and can worsen weight gain or blood sugar problems caused by some TKIs.

• Large amounts of alcohol, which can damage the liver and interact with TKIs and other medicines.

• Herbal or “mega-dose” supplements not checked with the doctor, especially strong green-tea extracts, high-dose vitamin A, or untested “leukemia cures,” because they may harm the liver or interact with TKIs.

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Frequently asked questions (FAQs)

1. Is chronic granulocytic leukemia the same as chronic myeloid leukemia?
Yes. Chronic granulocytic leukemia is an older name that doctors now mostly call chronic myeloid leukemia (CML). Both describe a blood cancer caused by the BCR-ABL1 fusion gene in bone-marrow cells.

2. Can CML be controlled with tablets only?
For many people in the chronic phase, a once-daily TKI tablet like imatinib or other modern TKIs can control the disease for years and sometimes decades. Some patients even reach such a deep remission that doctors may carefully try a treatment-free period under strict monitoring.

3. Will I need chemotherapy like other leukemias?
Most people with chronic-phase CML do not need traditional intensive chemotherapy. TKIs are the main treatment. Chemotherapy or other strong medicines may be used if the disease moves to blast phase or if transplant is planned.

4. How long do I have to stay on TKI treatment?
Many patients stay on TKIs for many years. In some people with very deep and stable molecular responses, doctors may discuss a carefully monitored treatment-free trial, but this is only under strict rules with frequent BCR-ABL testing. Stopping TKIs on your own is dangerous.

5. Can I go to school, college, or work with CML?
Many people with well-controlled CML continue study or work, especially once treatment is stable and side effects are managed. Some adjustments such as flexible hours or remote options may help on days with extra fatigue or hospital visits.

6. Is it safe to exercise?
In most cases, gentle to moderate exercise is not only safe but helpful. It can reduce fatigue, stress, and improve strength and mood. The best plan is agreed with the doctor and may change depending on blood counts and treatment stage.

7. Can I have children in the future?
Many people with CML can have children, but the timing must be planned with both the hematologist and an obstetrician. Some TKIs should not be used in pregnancy, so doctors may change or pause medicines under strict control and may suggest sperm or egg banking before certain treatments.

8. Will I lose my hair?
Standard TKIs used in CML do not usually cause complete hair loss like some chemotherapies. Some people notice hair thinning or texture changes, but this is often mild. Intensive chemotherapy used for blast-phase disease or transplant can cause more obvious hair loss.

9. What if a TKI stops working for me?
If blood counts or BCR-ABL levels start to rise, doctors may check for mutations and switch to another TKI or different treatment such as ponatinib, asciminib, omacetaxine, or even transplant, depending on the situation. Many patients can still achieve good control with second- or third-line treatments.

10. Can food or supplements cure my leukemia?
No. Healthy food and some supplements may support strength and immune function, but they cannot replace TKIs or other medical treatments. Some “natural cures” on the internet may even be dangerous or interact with medicines. Always discuss any supplement with your doctor before using it.

11. Will CML shorten my life?
Before TKIs, CML greatly shortened life expectancy. Today, many people treated early with TKIs have survival close to people without CML, especially when they take medicine regularly and attend follow-up. Risk is higher if disease is diagnosed late or progresses to advanced phases.

12. Is stem cell transplant always necessary?
No. For many patients in the TKI era, transplant is not needed. It is mainly considered for those with advanced disease, TKI resistance, or certain high-risk mutations. Because transplant has serious risks, doctors weigh benefits very carefully.

13. How often will I need tests?
In the beginning, blood counts and BCR-ABL tests are done quite often (for example every few weeks to months). When responses are stable, the gap between tests may be longer. The exact schedule follows international and local guidelines and your doctor’s advice.

14. Can stress make my leukemia worse?
Stress does not directly change the leukemia cells, but it can reduce sleep, appetite, and treatment adherence, and increase anxiety and depression. Using counseling, relaxation techniques, and social support can help you cope better and keep up with your treatment plan.

15. Where can I get reliable information?
Reliable sources include your hematology team, national cancer societies, leukemia foundations, and official drug-regulatory agency information pages, which give up-to-date data on approved medicines and their side effects. Be careful with websites promising quick cures or selling unproven products.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: January 25, 2025.