The goal in treating accelerated phase chronic myeloid leukemia (CML) and blast crisis phase CML is to eliminate all cells that have the BCR-ABL oncogene and achieve a remission. If all the oncogenes can't be destroyed, the goal is to return the disease to the chronic phase.
The BCR-ABL tyrosine kinase inhibitor (TKI) Gleevec® is FDA approved for adults with Ph positive CML in blast crisis phase, accelerated phase, or in chronic phase after failure of interferon alpha therapy. Other drug choices include Sprycel, Tasigna, Bosulif and Synribo.
A clinical trial is another treatment choice.
Other drugs may be combined with TKIs:
- Busulfan (Myleran®)
- Cytarabine (Cytosar-U®)
- Hydroxyurea (Hydrea®)
Some people with CML have very high white cell counts at the time of diagnosis. This can reduce blood flow to the brain, lungs, eyes and other parts of the body and cause damage to small blood vessels. Hydrea might be used to decrease the white cell count. After the white cell count drops, oral drug therapy such as Gleevec can be started.
For information about the drugs mentioned on this page, visit Drug Listings.
Patients with dangerously high white cell counts can have some white cells removed during a process called leukapheresis. A machine similar to a dialysis machine removes white cells from your blood. Once your white blood cell count decreases, you can begin oral therapy.
Leukapheresis can be a good choice for women diagnosed with CML in the first months of pregnancy, when drug therapy may be harmful to the unborn baby.
Stem Cell Transplantation
For some patients who don't respond to other treatment, stem cell transplantation may be an option.