CML — Chronic Myeloid Leukemia: Practical Guide
CML is a blood cancer driven by a specific changed gene called BCR-ABL. That change makes cells grow too fast. Most people with CML are diagnosed in the chronic phase, when treatment works best. This page gives clear, practical steps for spotting CML, getting the right tests, and staying on a treatment plan that works.
What to watch for
Early symptoms can be subtle: tiredness, night sweats, unexplained weight loss, enlarged spleen (feeling full on the left), or frequent infections. Sometimes a routine blood test shows high white blood cells before symptoms appear. If you notice these signs, ask your doctor for blood counts and a referral to a hematologist.
Diagnosis & tests
Diagnosis starts with a complete blood count (CBC) and blood smear. The key test is checking for the BCR-ABL gene. Labs use PCR or FISH to detect it. A bone marrow biopsy may be done to check disease phase: chronic, accelerated, or blast. Your doctor will explain test results and stage, which guide treatment choices.
After diagnosis, regular monitoring matters. PCR tests measure BCR-ABL levels in the blood. Good response means those numbers fall quickly. Your care team will track milestones like major molecular response (MMR) and deeper responses that predict long-term control.
Treatment & living with CML
First-line treatment is usually a tyrosine kinase inhibitor (TKI) such as imatinib, dasatinib, or nilotinib. TKIs target the BCR-ABL protein and can control CML for many years. You take these as daily pills. Common side effects include fatigue, nausea, muscle cramps, or mild skin issues. Most side effects are manageable with dose tweaks or supportive care.
Stick to your medication schedule. Missing doses reduces effectiveness and risks resistance. If side effects are strong, talk to your doctor before stopping. Sometimes switching between TKIs or adjusting dose solves the problem.
For people who don’t respond to TKIs or who progress to advanced phases, options include higher-intensity treatments or an allogeneic stem cell transplant. Transplant can cure CML but carries risks, so doctors reserve it for certain cases.
Follow-up care includes regular blood tests, PCR monitoring, and routine checks for side effects. Women who are pregnant or plan pregnancy should discuss timing with their hematologist—TKIs can affect pregnancy and need special handling.
Simple lifestyle steps help: eat balanced food, stay active as tolerated, avoid smoking, and keep vaccinations up to date. Bring a list of medications and supplements to every visit to avoid interactions.
If you’re newly diagnosed, ask your team about treatment goals, expected timeline for response, and what monitoring will look like. Get a reliable source for test results and keep copies. A second opinion can help if you face a complex choice.
Questions for your doctor: What phase is my CML? Which TKI do you recommend and why? How will we monitor response? When should I call about side effects? Clear answers make managing CML less stressful and more effective.
Apr, 26 2025