Chronic myeloid leukemia (CML), also called chronic myelogenous leukemia, is a blood cancer that starts in the bone marrow stem cells. A special change (mutation) happens where parts of chromosome 9 and chromosome 22 swap places. This creates the “Philadelphia chromosome” and a fusion gene called BCR-ABL1. This fusion gene makes an abnormal enzyme (a tyrosine kinase) that is always “on,” telling white blood cells to grow and divide too much.
Chronic myeloid leukemia (CML) is a blood cancer that starts in the bone marrow, which is the soft center inside your bones where blood cells are made. In CML, a change (mutation) happens in the genes of a stem cell that normally makes healthy white blood cells. This gene change creates an abnormal “fusion” gene called BCR-ABL1, also known as the Philadelphia chromosome. This new gene acts like a stuck accelerator pedal and tells the cell to keep making too many white blood cells that do not work properly. These cells build up in the blood and bone marrow over time and slowly crowd out normal red cells, platelets, and healthy white cells. If CML is not treated, it usually starts as a slow, chronic disease and can later change into a more aggressive leukemia.
Because of this constant growth signal, the bone marrow and blood fill up with too many abnormal white blood cells. Over time this can crowd out normal red cells, platelets, and healthy white cells. Many people are diagnosed in the chronic phase, when the disease is more stable and people may have few or no symptoms. Without treatment, CML can move to accelerated phase and then blast crisis, which behave more like acute leukemia and are much more dangerous.
Modern treatment focuses on blocking the BCR-ABL1 tyrosine kinase. Medicines called tyrosine kinase inhibitors (TKIs) directly turn off this abnormal signal. When TKIs are used correctly, many patients live almost a normal life span, and some reach such a deep response that treatment may later be stopped under specialist supervision.
Other names for chronic myeloid leukemia
Doctors and books may use several different names for the same disease. The most common names are chronic myeloid leukemia, chronic myelogenous leukemia, and the short form CML. Older books and some doctors also use chronic granulocytic leukemia (CGL), because many of the extra cells are a type of white blood cell called granulocytes. In modern classification systems, you may also see the name “CML, BCR-ABL1–positive” or “Philadelphia chromosome–positive CML”, which reminds us that the disease is defined by the BCR-ABL1 gene change. All these names refer to the same basic blood cancer.
Types of chronic myeloid leukemia
Doctors usually describe types of CML by phase, which shows how advanced and aggressive the disease is. The phases are based on how many very immature cells (called blasts) are seen in the blood or bone marrow and on other features such as symptoms and organ enlargement.
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Chronic phase CML: This is the earliest and most common phase. Most people are diagnosed here. The number of blasts is low, and many patients have few or no symptoms. Blood counts are abnormal, but the disease is usually well controlled with targeted tablets called tyrosine kinase inhibitors (TKIs).
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Accelerated phase CML: In this phase the leukemia cells grow faster, and the number of blasts or other abnormal features increases. People may feel more unwell, with worse fatigue or an enlarged spleen, and blood counts are harder to control. This phase is a warning that the disease is changing and may move toward blast crisis if not managed quickly.
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Blast phase (blast crisis) CML: This is the most advanced and dangerous phase. The disease behaves like an acute leukemia, with many blasts in the blood or bone marrow. Symptoms are usually severe, and the risk of serious infections and bleeding is high. Treatment becomes more difficult, and urgent intensive therapy is usually needed.
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Pediatric CML: CML can also occur in children and teenagers, although it is much less common than in adults. The basic biology is similar, but doctors may adjust tests and treatments to fit the age, growth, and long-term needs of younger patients.
Causes and risk factors of chronic myeloid leukemia
For most people with CML, doctors cannot find a clear outside cause. The key event is the gene change that creates the BCR-ABL1 fusion, but why this happens in one person and not another is often unknown. Only a few risk factors are well proven, and many others are still being studied.
1. Philadelphia chromosome (BCR-ABL1 fusion gene)
The main cause inside the body is a swap of DNA between chromosome 9 and chromosome 22, called translocation t(9;22). This creates the BCR-ABL1 fusion gene, which makes an abnormal protein that tells bone marrow cells to grow too fast and avoid normal controls. This genetic event defines CML and is found in almost all patients.
2. Random DNA mistakes in bone marrow stem cells
Every time a stem cell divides, its DNA must be copied. Sometimes random copying errors happen by chance. Most errors are harmless, but a rare one can create the BCR-ABL1 fusion or other leukemia-related changes. In many people with CML, no specific exposure is found, so the disease may start from such random DNA damage.
3. Aging of bone marrow stem cells
CML is more common in middle-aged and older adults. With age, stem cells have gone through more divisions and have had more time to collect small DNA errors. This natural aging process makes it more likely that a harmful change like BCR-ABL1 will appear in at least one cell.
4. High-dose ionizing radiation
Exposure to high levels of ionizing radiation, such as atomic bomb blasts, nuclear accidents, or very high-dose radiation therapy, is a proven risk factor for leukemia, including CML. Radiation can directly damage DNA, and this damage may lead to chromosome translocations like t(9;22) in stem cells.
5. Previous radiation therapy for another cancer
People who received strong radiation treatments for a different cancer may have a slightly higher risk of later developing CML. The radiation that treats the first cancer can also affect healthy bone marrow cells and cause long-term DNA damage, sometimes many years later.
6. Long-term benzene exposure
Benzene is a chemical found in some industrial workplaces, petrol, and cigarette smoke. Long-term exposure is clearly linked to some leukemias, and there is some evidence that it can also increase the risk of CML. Benzene damages bone marrow DNA and may contribute to the development of the Philadelphia chromosome.
7. Other cancer-causing chemicals at work
People who work for many years with chemicals such as certain solvents, dyes, or pesticides may have a higher general risk of blood cancers. These exposures can cause DNA damage, although links to CML specifically are weaker than for benzene and are still being studied.
8. Previous chemotherapy drugs
Certain chemotherapy drugs used to treat other cancers can later increase the risk of leukemia. These medicines also damage DNA in fast-dividing cells, including bone marrow stem cells. In rare cases, this treatment-related damage can lead to CML or other myeloid cancers years after the original therapy.
9. Older age
CML can occur at any age but is most often diagnosed in adults over 50. Getting older itself is a strong risk factor because of the accumulation of DNA damage over time. However, age is not something a person can change, and many older people never develop CML.
10. Male sex
CML is slightly more common in men than in women. The exact reasons are not fully understood. It may be related to differences in hormone levels, occupational exposures, lifestyle patterns, or other genetic or environmental factors.
11. Rare inherited susceptibility
CML usually does not run in families, and most people with CML have no close relative with the disease. However, very rare inherited gene patterns may slightly increase the chance that bone marrow cells will collect harmful changes. This is an area of ongoing research.
12. Other myeloproliferative or bone marrow disorders
People with certain long-standing bone marrow diseases may be at risk of their condition changing over time into a CML-like state or developing additional mutations such as BCR-ABL1. These situations are uncommon but show that unstable bone marrow can acquire new harmful gene changes.
13. Chronic immune activation and inflammation
Long-term inflammation in the body can produce chemicals called reactive oxygen species that can damage DNA. Although a direct link to CML is not clearly proven, chronic inflammatory states may add to overall DNA stress in bone marrow cells and slightly increase leukemia risk in general.
14. Being very overweight or obese
Obesity has been linked to a higher risk of several cancers. Extra fat tissue releases hormones and inflammatory substances that may affect how cells grow and repair DNA. Some studies suggest that high body weight may contribute to the risk of myeloid cancers, though links to CML specifically are still being clarified.
15. Limited physical activity
Lack of regular movement is associated with a higher risk of some cancers and metabolic problems. Exercise helps control weight, hormones, and inflammation. While direct evidence in CML is limited, low activity may act together with other factors like obesity to influence overall leukemia risk.
16. Smoking and tobacco exposure
Cigarette smoke contains benzene and many other cancer-causing substances. Research on smoking and CML risk has mostly shown no strong link, but smoke clearly raises risk for other leukemias and cancers. It may still add a small extra burden of DNA damage to bone marrow cells.
17. Environmental air pollution
Living or working in areas with high air pollution can expose a person to many harmful chemicals, including benzene-like compounds. These pollutants may slowly damage DNA in blood-forming cells. Direct proof for CML is limited, but air pollution is recognized as a general cancer risk factor.
18. Combination of radiation and chemical exposure
Some workers, such as those in nuclear or certain industrial settings, may be exposed to both radiation and chemicals over many years. Studies suggest that combined exposure can increase leukemia risk more than either factor alone, likely because multiple types of DNA damage are happening at the same time.
19. DNA repair problems inside cells
Our cells have repair systems that usually fix DNA breaks. In some people, these systems may work less efficiently because of subtle gene differences or long-term stress on the cells. When DNA repair is weaker, chromosome breaks such as the ones that create the Philadelphia chromosome are more likely to slip through.
20. No known external cause (“chance alone”)
For many people with CML, none of the above risk factors are present. The disease may still develop because of random DNA errors in stem cells that happen by chance and are not linked to lifestyle or environment. This is important to understand so patients do not blame themselves; most cases cannot be prevented with current knowledge.
Symptoms of chronic myeloid leukemia
CML often grows slowly at first, so some people have no symptoms and their disease is found on a routine blood test. When symptoms do appear, they are usually due to too many abnormal white cells, lack of normal blood cells, or an enlarged spleen.
1. Tiredness and weakness (fatigue)
Many people with CML feel very tired, weak, or “washed out” even after resting. This happens because the bone marrow is not making enough healthy red blood cells, leading to anemia, and because the body is using extra energy dealing with the leukemia cells.
2. Pale skin and shortness of breath
Low red blood cell levels can make the skin look pale and can cause shortness of breath during normal activities or climbing stairs. The heart and lungs have to work harder to deliver oxygen because there are fewer healthy red cells in the blood.
3. Unplanned weight loss
Some people lose weight without trying. This can happen because the body is constantly fighting the leukemia cells, which uses extra energy, and because appetite may be reduced due to feeling unwell or having an enlarged spleen pressing on the stomach.
4. Fever or feeling hot often
Low-grade fevers or a general feeling of warmth and illness can occur because the immune system is overactive and because the body releases chemical messengers called cytokines in response to the leukemia cells. These fevers are often not linked to a simple infection like the flu.
5. Night sweats
Many people with CML wake up at night with their clothes and sheets soaked in sweat. These night sweats are often heavy and may happen even when the room is cool. They are a common symptom in blood cancers and reflect the body’s response to abnormal cells.
6. Feeling full or discomfort under the left ribs
CML often makes the spleen bigger. The spleen sits under the ribs on the left side of the abdomen. When it enlarges, it can press on the stomach and nearby organs, causing a feeling of fullness after eating only a small amount, or causing pain or heaviness in that area.
7. Abdominal swelling or “tummy” discomfort
A very enlarged spleen or liver can make the belly look swollen and cause general discomfort, bloating, or a dragging feeling. This is especially common in more advanced CML phases where the number of leukemia cells is high.
8. Frequent infections
Even though the total number of white blood cells is high, these leukemia cells do not work normally. As a result, the body may not fight germs well, and a person with CML can get frequent or longer-lasting infections, such as repeated colds, chest infections, or skin infections.
9. Easy bruising and bleeding
CML can lower the number or quality of platelets, which are the cells that help blood clot. People may notice they bruise more easily, have nosebleeds, bleeding gums, or tiny red spots on the skin called petechiae. In advanced phases, bleeding can become more serious.
10. Bone and joint pain
Some patients feel deep, aching pain in bones or joints. This can happen because the bone marrow is very active and packed with leukemia cells, or because of expansion of the marrow space. Bone pain is more common in accelerated or blast phases.
11. Full-body itchiness (pruritus)
Itchy skin without a rash can occur in CML. The itch may be worse after a hot shower. It is thought to be caused by chemical messengers released by leukemia cells, changes in blood flow, or effects on tiny blood vessels in the skin.
12. Headache, dizziness, or vision changes
Very high white blood cell counts can make the blood thicker, a problem called hyperviscosity. This can reduce blood flow to the brain and eyes and may cause headaches, dizziness, blurred vision, or ringing in the ears. This situation is more likely in advanced disease.
13. Swollen lymph nodes
Some people may notice lumps in the neck, armpits, or groin caused by enlarged lymph nodes. This is less common in early-phase CML than in some other leukemias, but it can appear, especially if the disease is moving toward blast phase.
14. General feeling of being unwell (malaise)
Many patients describe a vague feeling of not being themselves, with low energy, loss of interest in normal activities, and reduced ability to work or study. This general malaise comes from the body’s response to chronic disease and anemia.
15. No symptoms at all in early stages
It is important to remember that some people with chronic phase CML feel completely normal. Their disease is discovered only because a routine blood test for something else shows very high white blood cell counts. This is why blood tests are a key part of diagnosis.
Diagnostic tests for chronic myeloid leukemia
Doctors use a mix of physical examination, manual bedside checks, laboratory and pathology tests, electrodiagnostic tests, and imaging tests to diagnose CML, measure how advanced it is, and monitor treatment. The most important tests look at blood counts, bone marrow, and the BCR-ABL1 gene.
Physical examination tests
1. Full physical exam and vital signs
The doctor begins with a general exam, checking weight, temperature, heart rate, breathing rate, and blood pressure. They look for signs of anemia (pale skin), fever, and general health. These findings help show how sick the person is and whether the leukemia may already be affecting organs such as the heart or lungs.
2. Abdominal exam for spleen size
The doctor gently presses on the abdomen to feel for an enlarged spleen under the left ribs and an enlarged liver on the right. In CML, the spleen is often enlarged and may extend down toward the belly button. Measuring how far it can be felt helps track disease activity over time.
3. Lymph node examination
The doctor feels the neck, armpits, and groin for enlarged lymph nodes. While big lymph nodes are less common in early CML, they may appear in advanced phases. This exam helps distinguish CML from other blood cancers and may suggest that the disease is changing into a more aggressive form.
4. Skin and mucous membrane check
The doctor looks at the skin and inside the mouth for bruises, tiny red spots (petechiae), or bleeding from gums. These signs suggest that platelets are low or not working well, which can occur in CML, especially when the disease is more advanced or the bone marrow is very crowded with leukemia cells.
Manual bedside tests
5. Symptom history and performance status
A careful conversation about symptoms—such as fatigue, weight loss, night sweats, and how well the person can perform daily tasks—is itself a kind of “manual test.” Doctors may use simple scales to rate how active a person is. This information helps stage the disease and decide how urgent treatment is.
6. Palpation and percussion of the spleen
The doctor uses their hands and gentle tapping to outline the spleen and estimate its size. This is a manual technique that helps detect enlargement even when imaging is not immediately available. Changes in spleen size over time can show whether treatment is working.
7. Manual liver span assessment
Using touch and tapping, the doctor checks how big the liver is. The liver may become enlarged if leukemia cells spread there or if blood flow is altered by an enlarged spleen. Knowing whether the liver is involved gives a better overall picture of disease burden.
8. Manual check for bone or sternal tenderness
By gently pressing on the breastbone (sternum) and other bones, the doctor looks for tenderness that could suggest very active bone marrow or high pressure inside the marrow spaces. While not specific to CML, this manual test supports other findings of an overactive marrow.
Laboratory and pathological tests
9. Complete blood count (CBC) with differential
A CBC measures the number of red blood cells, white blood cells, and platelets. In CML, the white blood cell count is usually very high, with many mature and immature granulocytes, while red cells and platelets may be low or high depending on the phase. The differential shows the detailed types of white cells present.
10. Peripheral blood smear
A drop of blood is spread on a glass slide and examined under a microscope. In CML, the smear shows many stages of granulocyte development, from myeloblasts to mature neutrophils, often with basophilia and eosinophilia. This picture strongly suggests a chronic myeloproliferative process like CML.
11. Bone marrow aspiration
A thin needle is inserted into a large bone, usually the hip, to suck out liquid marrow. Under a microscope, doctors can see how full the marrow is, what kinds of cells are present, and how many blasts exist. In CML, the marrow is typically very cellular with many granulocytic cells.
12. Bone marrow biopsy
A small core of bone and marrow is removed and examined. This shows the overall structure of the marrow and how crowded it is. The biopsy helps confirm CML, distinguish it from other disorders, and check for fibrosis or progression to accelerated or blast phase.
13. Cytogenetic testing (karyotyping) for Philadelphia chromosome
In this test, cells are grown in the lab and their chromosomes are stained and viewed. The classic finding in CML is the Philadelphia chromosome, created by the t(9;22) translocation. Seeing this abnormal chromosome helps confirm the diagnosis and provides a baseline to monitor treatment response.
14. Fluorescence in situ hybridization (FISH) for BCR-ABL1
FISH uses glowing (fluorescent) probes that stick to specific DNA sequences. In CML, probes for BCR and ABL1 can show whether the BCR-ABL1 fusion is present and in how many cells. FISH can be done on blood or marrow and is useful when karyotyping is difficult or when monitoring residual disease.
15. Quantitative PCR (qPCR) for BCR-ABL1
Quantitative PCR is a very sensitive test that measures the exact amount of BCR-ABL1 genetic material in the blood or marrow. It is used not only at diagnosis but also regularly during treatment to see how well the leukemia is responding. Results are often reported on an “international scale” to allow comparison over time.
16. Additional mutation testing (e.g., ABL kinase domain, other genes)
In some patients, especially if the disease is not responding well to therapy, doctors test for extra mutations in the BCR-ABL1 gene (such as those in the ABL kinase domain) or in other myeloid genes. These mutations can explain resistance to certain drugs and guide the choice of different TKIs or other treatments.
Electrodiagnostic tests
17. Electrocardiogram (ECG)
An ECG records the heart’s electrical activity. While it does not diagnose CML itself, it is important because some CML medicines can affect heart rhythm or prolong the QT interval. Checking the ECG before and during treatment helps keep the heart safe while using these targeted drugs.
18. Nerve conduction studies and electromyography (EMG)
These tests measure how well electrical signals travel along nerves and into muscles. They are not routine in CML but may be used if a person on treatment develops numbness, weakness, or other nerve-related symptoms. The tests help doctors see whether symptoms are due to drug side effects, other illnesses, or unrelated nerve problems.
Imaging tests
19. Abdominal ultrasound
Ultrasound uses sound waves to create pictures of organs. It can show the size of the spleen and liver and detect any masses or blood flow changes. In CML, ultrasound is often used to confirm spleen enlargement found on exam and to follow changes over time as treatment shrinks the spleen.
20. CT or MRI scans (and sometimes PET-CT)
Computed tomography (CT) and magnetic resonance imaging (MRI) create detailed images of the body. They are not needed for every patient but may be used if there are unusual symptoms, concern about organ damage, or to assess complications such as very large spleen, bone lesions, or suspected transformation to blast crisis. PET-CT may be used in special situations to look for active disease sites.
Treatment goals in chronic myeloid leukemia
The main goals of CML treatment are simple to say but complex to achieve. Doctors want to control the high white cell count, prevent progression to advanced phases, reduce the number of leukemia cells to extremely low levels, and keep you feeling well in daily life. In blood tests, this means getting the white cell count and platelets back to normal and slowly shrinking the amount of BCR-ABL1 detected by sensitive molecular tests.
In practice, treatment is usually long-term. Most people take TKIs every day for years. Alongside medicine, non-drug measures such as healthy food, exercise, infection prevention, and stress management are also very important. Regular follow-up with a hematologist and frequent lab monitoring are necessary to adjust doses and to catch side effects or loss of response early.
Non-pharmacological treatments
1. Education and counseling
Understanding CML, its phases, and your treatment plan reduces fear and confusion. Good education lets you know what side effects to expect and when to ask for help. This improves adherence to TKIs and long-term outcomes. Counseling can also support emotional health, help you accept a chronic cancer diagnosis, and involve family members in care.
2. Regular physical activity
Light to moderate exercise, such as walking, stretching, or cycling, helps reduce fatigue, supports heart health, and maintains muscle strength. It also improves mood and sleep. Exercise should be adapted to your energy level, blood counts, and joint or bone pain. Your doctor or a physiotherapist can suggest a safe program and tell you when to pause activity, for example during severe anemia or infection.
3. Balanced, nutrient-dense diet
A diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats supports the immune system and helps the body handle long-term TKI therapy. Good nutrition can prevent weight loss, weakness, and vitamin deficiencies. Small, frequent meals may help if you feel nauseous. A dietitian who knows about cancer care can customize a plan around your culture, taste, and other health problems like diabetes.
4. Infection prevention and hygiene
Because CML and its treatments can affect the immune system, simple infection-control steps are important. These include regular hand-washing, avoiding people with obvious infections, careful food hygiene, and dental care. Vaccines such as influenza and COVID-19 may be recommended according to guidelines. Good infection prevention lowers the risk of serious complications, hospital stays, and treatment interruptions.
5. Stress management and psychological support
Living with a long-term blood cancer can cause anxiety, sadness, or sleep problems. Relaxation techniques like deep breathing, mindfulness, meditation, or prayer can reduce stress hormones and improve quality of life. Psychologists, counselors, or support groups give a safe space to talk about fears, family, work, and money issues. Better mental health often leads to better treatment adherence.
6. Support groups and peer support
Meeting others with CML, either in person or online, helps you feel less alone. Hearing real-life experiences about TKIs, side effects, and coping strategies is often very encouraging. Peer support can also provide practical tips about work, family, sexual health, and travel. Many patients say that support groups give them hope and motivation to stay on treatment.
7. Sleep hygiene and fatigue management
Fatigue is one of the most common problems in CML, sometimes from the disease and sometimes from TKIs. Good sleep habits—keeping a regular sleep schedule, limiting screens before bed, and creating a quiet, dark bedroom—can help. Short daytime rests, pacing your activities, and prioritizing important tasks can also reduce exhaustion and improve daily functioning.
8. Smoking cessation
If you smoke, quitting is one of the best things you can do for your health. Smoking damages blood vessels, reduces oxygen delivery, and increases infection and heart risks. Some TKIs already increase cardiovascular risk, so smoking adds extra danger. Stopping smoking improves breathing, circulation, and long-term survival, and may lower complications from TKI therapy.
9. Alcohol moderation or avoidance
Excess alcohol can damage the liver and interact with medicines. Many TKIs and other drugs are processed through the liver, so heavy drinking can increase the risk of liver inflammation and abnormal liver tests. Limiting or avoiding alcohol helps protect the liver, reduces falls and injuries, and supports better sleep and mood.
10. Weight management and metabolic health
Some TKIs can raise blood sugar or cholesterol. Being overweight adds extra strain on the heart and joints. A healthy diet plus regular exercise helps maintain a normal weight, improves insulin sensitivity, and reduces blood pressure. This lowers the risk of heart disease and stroke during long-term CML treatment.
11. Physiotherapy and gentle rehabilitation
Bone pain, muscle aches, and weakness are common in CML and can be worsened by treatment. A physiotherapist can design stretching, strengthening, and posture exercises tailored to your situation. This helps maintain mobility, reduce stiffness, and prevent falls. Gentle rehabilitation also supports independence in daily activities.
12. Occupational therapy and work adjustment
Occupational therapists can help you adapt your daily tasks at home and at work. They may suggest energy-saving techniques, helpful tools, or changes in your work schedule. This allows many people with CML to continue working or studying, which supports financial stability and emotional well-being.
13. Safe pregnancy planning and fertility counseling
Some TKIs can harm a developing baby, and CML itself may affect fertility. Fertility specialists and hematologists can work together to plan safe timing of pregnancy, possible treatment pauses, or alternative medications. Options like sperm banking or egg/embryo freezing may be discussed before intensive treatments such as stem cell transplant.
14. Pain management techniques (non-drug)
Heat packs, cold packs, relaxation, gentle massage, and positioning techniques can reduce mild to moderate pain from bone marrow expansion or muscle tension. These non-drug measures can be combined with medicines when needed and may reduce the amount of pain medicine required.
15. Nutritional counseling for side effects
TKIs often cause nausea, diarrhea, or loss of appetite. A dietitian can suggest specific foods and eating patterns to manage each symptom—for example, bland foods and small meals for nausea, extra fluids and soluble fiber for mild diarrhea, or higher-calorie snacks when you are losing weight. This helps you stay strong enough to continue treatment.
16. Sun protection and skin care
Some CML drugs make the skin more sensitive to sunlight. Using sunscreen, wearing protective clothing, and avoiding midday sun can reduce rashes, burns, and long-term skin damage. Simple moisturizers help prevent dry or itchy skin, which is also a common side effect of therapy.
17. Financial and social work support
Long-term cancer care can be expensive and stressful for families. Social workers can help you understand insurance coverage, access patient assistance programs, and find community resources. Reducing financial stress allows you to focus on health and treatment rather than constant money worries.
18. Complementary mind-body approaches (with medical guidance)
Some people find benefit from yoga, tai chi, guided imagery, or acupuncture for stress, sleep, and pain. These approaches should never replace TKIs but can sometimes be used alongside them if your hematologist agrees. The key is choosing safe practices and avoiding unproven “cures” that promise to replace standard treatment.
19. Oral care and dental hygiene
CML and some treatments can increase risk of gum bleeding and mouth infections. Regular brushing with a soft toothbrush, flossing gently, and routine dental visits help protect your mouth. Dentists should know you have CML, so they can adjust procedures and coordinate with your hematologist if your platelets or white cells are low.
20. Vaccination and preventive health checks
Staying up-to-date with recommended vaccines, such as influenza, COVID-19, and possibly pneumonia vaccines, lowers infection risk. Routine health checks for blood pressure, cholesterol, and blood sugar are very important during long-term TKI therapy, because some TKIs can affect the heart and circulation. Preventive care supports safe, long-term survival with CML.
Drug treatments for chronic myeloid leukemia
Dose information below is based on FDA prescribing information and is meant for education only. Your exact dose and schedule must always be decided by your hematologist.
1. Imatinib (Gleevec, Imkeldi) – first-generation TKI
Imatinib was the first TKI that changed CML from a deadly disease to a manageable condition. It blocks the BCR-ABL1 tyrosine kinase and reduces leukemia cells. Typical adult doses are around 400 mg once daily for chronic-phase CML, with higher doses in advanced phases, taken with food and water. Common side effects include fluid retention, nausea, cramps, rash, and low blood counts.
2. Dasatinib (Sprycel, Phyrago) – second-generation TKI
Dasatinib is a more potent TKI that can work when imatinib stops working or is not tolerated, and it is also approved for newly diagnosed chronic-phase CML. Usual adult doses are about 100 mg once daily for chronic phase and 140 mg daily for advanced phases. It can cause low blood counts, fluid around the lungs, diarrhea, headache, and bleeding risk, so regular monitoring is essential.
3. Nilotinib (Tasigna) – second-generation TKI
Nilotinib also targets BCR-ABL1 and is often used when imatinib is not suitable or as a first-line option in some guidelines. It is usually taken twice daily on an empty stomach. Side effects can include changes in blood sugar, cholesterol increases, QT prolongation on the ECG, and low blood counts, so heart and metabolic monitoring are important.
4. Bosutinib (Bosulif) – second-generation TKI
Bosutinib is approved for patients with CML who have resistance or intolerance to prior TKIs and in some regions for newly diagnosed cases. It inhibits BCR-ABL1 as well as some SRC kinases. It is taken once daily with food. Diarrhea, liver test abnormalities, and low blood counts are frequent side effects, so close follow-up is required.
5. Ponatinib (Iclusig) – third-generation TKI
Ponatinib is a powerful TKI designed to work against CML with the T315I mutation, a common cause of resistance. It is usually reserved for patients who have failed multiple TKIs or have this specific mutation. It carries higher risks of blood clots, heart problems, and high blood pressure, so doses are carefully adjusted, and cardiovascular risk factors are aggressively managed.
6. Asciminib (Scemblix) – STAMP inhibitor
Asciminib is a newer drug that targets the myristoyl pocket of ABL rather than the usual ATP-binding site. It is approved for adults with Ph+ CML in chronic phase, including newly diagnosed patients and those previously treated with multiple TKIs or with T315I mutation. It is taken by mouth, usually once or twice daily, and may cause fatigue, headache, low blood counts, and pancreatic or liver test abnormalities.
7. Omacetaxine mepesuccinate (Synribo)
Omacetaxine is not a TKI. It blocks protein synthesis in leukemia cells and is used in CML that has failed at least two TKIs. It is given by subcutaneous injection in cycles. Important side effects include severe low blood counts and infection risk, so it is usually given in specialist centers with careful monitoring.
8. Hydroxyurea (Hydroxycarbamide)
Hydroxyurea is often used briefly at diagnosis to lower very high white cell counts while waiting for TKI approval or to control counts if TKIs are delayed. It interferes with DNA synthesis in rapidly dividing cells. It is taken by mouth and can cause low blood counts, mouth sores, and skin changes with long-term use.
9. Interferon-alpha (standard or pegylated forms)
Interferon-alpha is an older treatment that boosts the immune system’s attack on leukemia cells. It is now mainly used in special cases, such as during pregnancy when TKIs are avoided. It is injected under the skin several times a week or less often for pegylated forms. Side effects include flu-like symptoms, depression, and low blood counts.
10. Allopurinol
Allopurinol is used to prevent or treat high uric acid levels that can occur when many leukemia cells are destroyed quickly (tumor lysis syndrome). It blocks xanthine oxidase, an enzyme that helps make uric acid. Typical dosing is once to three times daily, depending on kidney function. Side effects include rash and rare severe allergic reactions.
11. Rasburicase
Rasburicase is another medicine for high uric acid in high-risk tumor lysis. It breaks down uric acid into a more soluble compound. It is given intravenously in the hospital. Because of possible allergic reactions and breakdown of red cells in people with G6PD deficiency, it is used with careful monitoring.
12. Anti-nausea medicines (e.g., ondansetron)
TKIs can cause nausea and vomiting. Medicines like ondansetron block serotonin receptors in the gut and brain to reduce nausea. They are taken by mouth or given by injection before or after TKI dosing. Common side effects include constipation and headache. Controlling nausea helps patients keep taking life-saving CML medicine.
13. Proton pump inhibitors or H2 blockers (with caution)
These medicines, such as omeprazole or famotidine, reduce stomach acid and help with reflux or stomach upset. However, acid-reducing drugs can change how some TKIs are absorbed, so they must be used only under medical advice. Side effects may include headache, diarrhea, and, with long-term use, nutrient deficiencies.
14. Diuretics (e.g., furosemide)
Diuretics may be used if CML or its treatment causes fluid overload or swelling. They make the kidneys pass more salt and water. Typical dosing is once or twice daily. Side effects can include low potassium, dizziness, and dehydration, so blood electrolytes are checked regularly.
15. Corticosteroids (e.g., prednisone)
Steroids may be used short-term to manage severe immune reactions, fluid around the lungs, or allergic side effects from other drugs. They reduce inflammation and immune activity. Doses vary widely based on the problem. Side effects include high blood sugar, mood changes, infection risk, and bone thinning with long-term use.
16. Growth factors for neutrophils (e.g., filgrastim)
In some situations, doctors may use drugs that stimulate white cell production to treat severe neutropenia (very low neutrophils). These are injections that encourage the bone marrow to release more white cells. They can cause bone pain and must be balanced carefully with leukemia control.
17. Erythropoiesis-stimulating agents (e.g., epoetin alfa)
If anemia is severe and clearly not due to uncontrolled leukemia, doctors may use drugs that stimulate red blood cell production. These agents are usually injections. They can improve fatigue but may increase clotting risk, so they are used cautiously and under strict guidelines.
18. Platelet transfusions
When platelet counts become dangerously low, platelet transfusions reduce bleeding risk. This is not a drug in the classic sense, but it is an important biological therapy. Side effects can include allergic reactions or, rarely, transfusion-related complications.
19. Red blood cell transfusions
If anemia is severe and causing symptoms such as shortness of breath or chest pain, red blood cell transfusions may be needed. They quickly raise hemoglobin. Risks include reactions, iron overload with repeated transfusions, and infection risk, although modern blood screening makes infections rare.
20. Broad-spectrum antibiotics and antifungals (when neutropenic)
If your neutrophil count is very low and you have a fever, doctors may start strong intravenous antibiotics or antifungals right away. These drugs treat or prevent life-threatening infections when your immune system is weak. Side effects depend on the specific medicine and can include kidney, liver, or hearing problems, requiring careful monitoring.
Dietary molecular supplements
1. Vitamin D
Vitamin D helps regulate immune function, bone health, and muscle strength. Many people with chronic illness have low levels. A typical supplement might be 800–2000 IU daily, but dosing should follow blood test results and doctor advice. By supporting bone metabolism and immune balance, vitamin D may help you tolerate long-term treatment and maintain strength.
2. Omega-3 fatty acids (fish oil)
Omega-3 fats have anti-inflammatory and heart-protective effects. Common doses range from 500–2000 mg of EPA+DHA daily. They may help counteract TKI-related cholesterol changes and reduce cardiovascular risk when combined with lifestyle changes. Possible side effects include mild stomach upset and, in high doses, a slightly increased bleeding tendency.
3. Probiotics
Probiotic supplements contain beneficial bacteria that support gut health. They may improve diarrhea or constipation and enhance nutrient absorption, especially when you take many medicines. Typical doses vary by product but often range from billions of colony-forming units daily. People with very low white cell counts should only use probiotics under medical guidance.
4. Curcumin (turmeric extract)
Curcumin has antioxidant and anti-inflammatory properties in laboratory studies. Doses in supplements often range from 500–1500 mg daily, ideally with black pepper extract to improve absorption. It may help joint pain and general inflammation, but it can interact with blood thinners and other medicines, so medical advice is essential.
5. Green tea extract (EGCG)
Green tea contains catechins like EGCG with antioxidant effects. Low to moderate supplemental doses may support cardiovascular health and metabolism. High-dose extracts can stress the liver, especially when combined with other medicines, so they must be used cautiously. Drinking brewed green tea is usually safer than concentrated pills.
6. Selenium
Selenium is a trace mineral important in antioxidant enzymes and thyroid function. Typical supplement doses are 50–200 mcg daily. Inadequate selenium can impair immune function, but excess intake can cause hair loss, nail changes, and nerve problems. Because TKIs may affect liver and thyroid, selenium should be monitored and supervised.
7. Zinc
Zinc supports immune function, wound healing, and taste. Supplements usually range from 10–25 mg per day. Short-term zinc may help with recurrent infections, but high doses can cause copper deficiency and anemia. You should avoid megadoses and tell your doctor about any zinc products you use.
8. Vitamin B12 and folate
B12 and folate are essential for red blood cell production and DNA synthesis. Long-term illness or certain medicines can lower levels. Supplements are commonly 400–800 mcg for folic acid and 250–1000 mcg for B12, adjusted based on blood tests. Correcting deficiencies can improve anemia and fatigue, but they do not treat CML itself.
9. Coenzyme Q10 (CoQ10)
CoQ10 plays a role in energy production in cells and has antioxidant properties. Doses often range from 50–200 mg daily. Some people report improved energy and heart health, which may be useful if TKIs affect cardiovascular risk. Side effects are usually mild, such as stomach upset or headache.
10. L-glutamine
L-glutamine is an amino acid important for gut lining cells and immune cells. It may help when appetite is poor or during times of stress, with typical supplemental doses from 5–15 g daily divided into smaller doses. People with liver disease or certain metabolic conditions should use it only under medical supervision.
Immunity-booster and regenerative / stem cell–related drugs
1. Filgrastim (G-CSF)
Filgrastim is a lab-made version of granulocyte colony-stimulating factor, which tells the bone marrow to make more neutrophils. It is given by subcutaneous injection. It helps recover white counts after intensive treatments or during severe infections. Side effects include bone pain and rare splenic enlargement or rupture, so use is carefully monitored.
2. Pegfilgrastim
Pegfilgrastim is a long-acting form of G-CSF. A single injection can support neutrophil counts over a longer period. It is often used during chemotherapy cycles, though less commonly needed with standard CML TKIs. Side effects are similar to filgrastim, and careful assessment is needed in leukemia patients.
3. Epoetin alfa and darbepoetin alfa
These drugs mimic erythropoietin, a natural hormone that stimulates red blood cell production. They are used for certain types of anemia when benefits outweigh risks. In CML, they may be considered when anemia is not due to uncontrolled disease. Side effects include high blood pressure and increased risk of blood clots.
4. Thrombopoietin receptor agonists (e.g., eltrombopag)
These medicines stimulate platelet production by activating the TPO receptor on bone marrow cells. They are mainly used for immune thrombocytopenia and some marrow failure conditions but may occasionally be considered in complex CML cases under specialist care. They can increase clotting risk and may affect liver tests.
5. Hematopoietic stem cell transplantation (HSCT)–related conditioning drugs
Before an allogeneic stem cell transplant, patients receive combinations of chemotherapy and sometimes radiation to wipe out diseased marrow and make space for donor cells. Drugs such as busulfan, cyclophosphamide, or fludarabine are used. They are toxic but allow donor stem cells to engraft and replace the leukemic marrow.
6. Mesenchymal stem cell–based therapies (emerging)
Experimental therapies use mesenchymal stem cells to support bone marrow repair and immune regulation after transplantation or severe marrow damage. These approaches are still under study and not standard CML treatment. Possible benefits include better graft tolerance and reduced graft-versus-host disease, but long-term safety is still being researched.
Surgical and procedural treatments
1. Allogeneic hematopoietic stem cell transplantation (allo-HSCT)
Allo-HSCT replaces a patient’s diseased bone marrow with healthy stem cells from a donor. It is considered when CML is in advanced phase, when TKIs fail, or when there is a high-risk mutation. The procedure involves intensive conditioning, infusion of donor cells, and a long recovery period. It can potentially cure CML but carries risks like infections and graft-versus-host disease.
2. Central venous catheter (CVC) placement
A CVC is a long, thin tube inserted into a large vein in the chest or neck. It allows blood draws, transfusions, chemotherapy, and stem cell infusions without repeated needle sticks. It is placed by a minor surgical procedure under local or general anesthesia. Risks include infection and clot formation around the catheter.
3. Leukapheresis
Leukapheresis is a procedure that rapidly removes white blood cells from the blood using a special machine, similar to dialysis. It is used in emergencies when white counts are extremely high and there is risk of leukostasis (sludging of thick blood in small vessels). It is usually a temporary measure until TKIs and other treatments take effect.
4. Splenectomy
If the spleen becomes very enlarged and painful, or is destroying too many blood cells, surgical removal (splenectomy) may be considered. This is now rare in CML because TKIs usually shrink the spleen. After splenectomy, infection risk increases, so vaccines and sometimes preventive antibiotics are needed.
5. Bone marrow (or bone marrow plus trephine) biopsy
Although not a “surgery” in the classic sense, bone marrow biopsy is an invasive procedure that removes a small core of marrow from the hip bone. It is used to diagnose CML, assess fibrosis, and monitor disease phase. Local anesthesia is used. Mild pain and bruising at the site are common but usually short-lived.
Prevention and risk-reduction strategies
1. Take TKIs exactly as prescribed
The most powerful way to prevent CML progression is to take your TKI every day as directed, without skipping doses. Adherence strongly affects molecular response and long-term survival.
2. Attend all scheduled follow-up visits and blood tests
Regular monitoring of blood counts and BCR-ABL1 levels helps catch problems early. If your response slows or side effects appear, your doctor can adjust the dose or switch drugs promptly.
3. Control cardiovascular risk factors
Because some TKIs increase risks of clots and heart disease, controlling blood pressure, cholesterol, diabetes, smoking, and weight is a key preventive step.
4. Vaccinate according to medical advice
Vaccines against influenza, COVID-19, and possibly pneumococcal disease can prevent serious infections that might interrupt treatment or cause hospitalization.
5. Practice strict infection-control measures
Hand-washing, avoiding people with active infections, and prompt treatment of fevers help reduce dangerous infections, especially when blood counts are low.
6. Avoid unproven “alternative cures”
Stopping TKIs to try herbal cures or extreme diets can allow CML to progress quickly. Any supplement or alternative therapy should be discussed with your hematologist to check for interactions or risks.
7. Protect liver and kidneys
Avoid unnecessary alcohol, high-dose painkillers like NSAIDs without supervision, and over-the-counter remedies that strain the liver or kidneys. These organs clear many CML medicines.
8. Manage sun exposure
Because some TKIs increase skin sensitivity, wearing protective clothing and sunscreen prevents burns and reduces long-term skin damage and cancer risk.
9. Maintain good oral and dental health
Healthy gums and teeth reduce the chance of bacteremia (bacteria in the blood) and serious infections, which can be more dangerous in people with leukemia.
10. Plan pregnancies carefully
Since many TKIs can harm a developing baby, pregnancy should be carefully planned with your hematologist and obstetrician. This helps prevent harm to both mother and child while keeping CML under control.
When to see a doctor urgently
You should seek urgent medical attention or contact your hematology team immediately if you have a fever above 38°C, chills, or signs of infection such as painful swallowing, a new cough, burning with urination, or large skin redness. In people with CML, these may signal a serious infection, especially if your white cell counts are low.
Other emergency warning signs include sudden shortness of breath, chest pain, confusion, severe headaches, vision changes, or weakness on one side of the body. These may indicate blood clots, bleeding, or very high white counts affecting blood flow. Heavy bleeding, black stools, or vomiting blood also require immediate care.
You should also contact your doctor soon (but not necessarily in the emergency room) if you notice new or rapidly increasing fatigue, night sweats, significant weight loss without trying, fast-growing lumps, worsening bone pain, or a quickly enlarging spleen (a feeling of fullness or pain under the left ribs). These can be signs that CML is changing phase or that treatment is no longer working as expected. Any new serious side effect from your medicines should be discussed promptly.
What to eat and what to avoid
Helpful foods to eat
Focus on a colorful, plant-rich diet with plenty of fruits, vegetables, whole grains, legumes, nuts, and seeds. These foods provide vitamins, minerals, fiber, and antioxidants that support the immune system and gut health. Choose lean proteins such as fish, chicken, eggs, tofu, and lentils to help maintain muscle mass and support healing. Healthy fats from olive oil, avocados, and nuts support heart health, which is important during long-term TKI therapy.
Drink enough clean water and other safe fluids to stay well hydrated, especially if you have diarrhea, fever, or are taking medicines that can affect the kidneys. If appetite is low, try small, frequent meals and energy-dense snacks like yogurt, nut butters, and smoothies. Food should be well-cooked to reduce infection risk, particularly when your neutrophils are low.
Foods and habits to limit or avoid
Avoid or minimize raw or undercooked meat, fish, and eggs, unpasteurized milk or juices, and poorly washed raw vegetables, especially when your immune system is weak, to reduce infection risk. Limit highly processed foods high in sugar, trans fats, and salt, as they add calories without nutrients and can worsen heart and metabolic risks. Reduce sugary drinks and excessive sweets, which can contribute to weight gain and high blood sugar. Limit alcohol because it stresses the liver and can interact with your medicines. Avoid herbal products and high-dose supplements unless your doctor approves, since some can interfere with TKIs or increase bleeding or liver toxicity.
Frequently asked questions (FAQs)
1. Is chronic myeloid leukemia curable?
CML is often described as a controllable chronic disease rather than easily curable. TKIs can push leukemia cells down to very low levels and let many people live a normal lifespan. A small group of patients can safely stop treatment under strict monitoring and remain in treatment-free remission. Allogeneic stem cell transplant can be curative but carries significant risks.
2. How long do I need to take TKI therapy?
Most people take TKIs for many years, often for life. Doctors track your molecular response with BCR-ABL1 tests at regular intervals. Only if you have a deep, stable molecular response for a long time, and meet strict criteria, might your team discuss a carefully supervised treatment-free trial.
3. What happens if I miss a dose of my TKI?
Occasional missed doses may happen, but frequent skipping can reduce the drug’s effect and increase the risk of losing response or developing resistance. If you miss a dose, follow the instructions in your drug’s patient guide or ask your doctor. Do not double up without medical advice.
4. Can chronic myeloid leukemia turn into acute leukemia?
Yes. Without effective treatment, CML can progress from chronic phase to accelerated phase and then blast crisis, which behaves like acute leukemia. With modern TKIs, this progression is much less common, especially when treatment is started early and taken regularly.
5. Can I live a normal life with CML?
Many people with CML work, study, have families, and travel normally. You may need to adjust your schedule for appointments and side effects, but with good disease control and self-care, quality of life is often good. Support from family, employers, and healthcare teams is very helpful.
6. Is CML inherited from parents?
No. CML is caused by an acquired mutation in bone marrow cells during life, not by a mutation passed from parents through egg or sperm. Most patients have no clear environmental cause. Family members usually do not have a higher risk of CML than the general population.
7. Are there foods that can “cure” CML?
There are no foods or natural products that can cure CML or replace TKIs. A healthy diet supports your body and helps you tolerate treatment, but it cannot switch off the BCR-ABL1 tyrosine kinase by itself. Claims of “natural cures” should be viewed with great caution.
8. Can I fast or follow special diets while on CML treatment?
Some people consider fasting or special diets for general health. However, long or extreme diets can cause weight loss, weakness, and deficiencies that interfere with treatment. Because some TKIs must be taken with food or on an empty stomach, any special diet should be discussed with your hematologist and dietitian first.
9. What side effects are most common with TKIs?
Common side effects include fatigue, nausea, diarrhea, fluid retention (swelling around eyes or ankles), muscle cramps, skin rashes, and low blood counts. Different TKIs have different patterns, such as cardiovascular risk with some second- and third-generation drugs or lung fluid with dasatinib. Regular monitoring and early management keep most side effects manageable.
10. Can I get vaccinated while on CML treatment?
In general, inactivated (non-live) vaccines, like flu shots and COVID-19 vaccines, are recommended because they reduce serious infection risk. Live vaccines are usually avoided or delayed in patients with leukemia. Always discuss vaccines with your hematologist before receiving them.
11. Can women with CML become pregnant safely?
Many women with CML can have healthy pregnancies, but careful planning is essential because TKIs can harm a baby. Often, TKIs are stopped or switched to interferon-alpha during pregnancy. These decisions depend on disease control and personal priorities and must be made with both hematologist and high-risk obstetrician.
12. Do TKIs interact with other medicines?
Yes. Many TKIs are metabolized by liver enzymes like CYP3A4, so drugs that strongly induce or inhibit these enzymes can change TKI levels. Grapefruit juice, certain antibiotics, antifungals, seizure medicines, and herbal products like St. John’s wort can cause interactions. Always show your doctor and pharmacist a list of every medicine and supplement you take.
13. How often will I need blood and molecular tests?
At the beginning, blood counts and BCR-ABL1 tests are quite frequent—often every 3 months for molecular tests and even more often for regular blood counts. As your condition stabilizes, intervals may become longer. Keeping these appointments allows your team to confirm that treatment is still working well.
14. Is stem cell transplant still used in CML?
Yes, but far less often than before TKIs. Today, allo-HSCT is reserved for patients with advanced-phase disease, those with TKI-resistant mutations not controlled by newer drugs, or those who fail multiple TKIs. When successful, transplant can be curative, but it carries higher short- and long-term risks than TKI therapy.
15. What is the long-term outlook for someone with CML today?
Thanks to TKIs and newer agents like asciminib, many patients in chronic phase have a near-normal life expectancy when diagnosed early and treated consistently. The prognosis depends on phase at diagnosis, response to TKIs, side effects, and other health problems. Close partnership with your hematology team, healthy lifestyle choices, and regular monitoring give you the best chance of excellent long-term outcomes.
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.
