Chronic Myeloid Leukaemia
4 medicines
Chronic myeloid leukaemia (CML) is a blood cancer driven by the BCR-ABL gene fusion, treated with targeted tyrosine kinase inhibitors such as imatinib.
Key facts
- Chronic myeloid leukaemia (CML) is a blood cancer that starts in the bone marrow, where a genetic rearrangement called the Philadelphia chromosome drives abnormal white blood cells to multiply unchecked.
- It progresses through three phases: chronic (often manageable for years), accelerated, and blast crisis; most people are diagnosed in the chronic phase, often after a routine blood test shows an unexpectedly high white cell count.
- First-line treatment is a tyrosine kinase inhibitor such as imatinib, with dasatinib or nilotinib used if imatinib is not tolerated or the disease progresses.
- Any new bone pain, fever, rapid weight loss, or a noticeably enlarging spleen warrants prompt medical review.
What causes CML
CML arises from a specific swap of material between chromosomes 9 and 22, producing the BCR-ABL fusion gene. This gene codes for a constantly active enzyme (a tyrosine kinase) that drives uncontrolled cell growth. It is not inherited and has no known lifestyle trigger. CML accounts for roughly 15% of adult leukaemias, and the average age at diagnosis is the mid-forties.
Targeted treatment: tyrosine kinase inhibitors
Tyrosine kinase inhibitors (TKIs) transformed CML from a disease with poor long-term outcomes into one where sustained remission is realistic for most people. First-line treatment typically starts with imatinib, the original BCR-ABL inhibitor. When imatinib is not tolerated or the disease progresses, second-generation agents dasatinib and nilotinib are used; both achieve deeper molecular responses in many patients. Hydroxycarbamide is sometimes used to bring down a very high white cell count while TKI therapy gets started. These sit alongside other oncology support medicines used across cancer care.
Monitoring and follow-up
Regular PCR monitoring of BCR-ABL transcript levels is essential to confirm a treatment is working and to catch early signs of resistance. Most people stay on TKI therapy long-term, with dose or drug adjustments guided by these results.
When to see a doctor
Any new bone pain, unexplained fever, rapid weight loss, or a noticeably enlarging spleen warrants prompt medical review, whether at diagnosis or during treatment.
This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.