Personalized Treatment
As a highly specialized center, we focus on the distinct needs of people with leukemia. We provide a very personalized approach to your care.
We view every patient as an individual, with unique needs and expectations. We take time to involve you and your family in each step of the treatment process. As you go through treatment, you will have access to a full range of support resources — from nutrition services to integrative therapies — that we provide to support you and your family.
Older Adult Hematologic Malignancy Program
Our Older Adult Hematologic Malignancy Program is a specialized Dana-Farber Brigham Cancer Center research and clinical service that addresses the specialized needs of blood cancer patients age 75 and older. Geriatricians work closely with oncologists to create individualized treatment plans for older patients that take into account other illnesses or concerns. These patients may participate in research protocols tailored to older adults, including clinical trials and tissue banking efforts.
Treatment Options for Chronic Myelogenous Leukemia
The treatment for CML has been revolutionized by the advent of the medication imatinib and the second- and third-generation tyrosine kinase inhibitors (TKIs) for CML. These are oral medications taken daily. They work to inhibit the function of the BCR-ABL gene. Many patients take these medications for the rest of their lives. In some instances, a patient may need treatment with a stem cell transplant.
We look at several factors, including risk level, phase of the disease, diagnostic findings, and side effect profiles, to determine which tyrosine kinase inhibitor (TKI) to include as part of your therapy. Treatment has several goals. The first is the restoration of your blood counts to normal (hematologic response). More important, however, is to lower or eliminate the number of cells that have the Philadelphia chromosome. Patients will be tested and monitored using bone marrow biopsies and blood tests to determine cytogenetic and molecular response. Cytogenetic and molecular responses are achieved over several months and years, respectively.
A distinguishing area of our expertise is evaluating how well you respond to therapy on a molecular level through sensitive testing.
Treatment of CML may include the following:
Targeted Therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Tyrosine kinase inhibitors (TKIs) are targeted therapy drugs often used as treatment for newly diagnosed patients with chronic phase CML. TKIs, such as imatinib and others, can stop the BCR-ABL enzyme from working, which causes the CML cells to die.
Most of the time, patients respond well to TKIs. Ultimately, the goal is to go into a cytogenetic remission, and then as deep a molecular remission as possible. This can take months or years to achieve. Patients are typically monitored 3 to 4 times a year after the first year to ensure that the disease is still responding to medication. Currently, we recommend that most patients remain on some form of TKI indefinitely, but some patients are able to come off and stay off their medications.
Stem Cell Transplant
Allogeneic stem cell transplant may be considered if the disease stops responding to TKI treatment. During an allogeneic transplant, diseased bone marrow cells are replaced with healthy ones from a donor. These new stem cells grow into (and restore) the body's blood cells. This treatment offers the only potential for a cure for CML. Dana-Farber Brigham Cancer Center has one of the largest and most experienced stem cell transplantation programs in the country.
Chemotherapy
Chemotherapy may be considered if targeted therapy and a stem cell transplant are not effective. Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Treating Resistant Disease
In some cases, CML may become resistant to treatment. Fortunately, there are options available. You will have more testing, and we will discuss your treatment options. These may include targeted therapy used in a different combination or given at a different dose, or a stem cell transplant.
Your Care
You will be assigned to one of our leukemia physicians as your primary oncologist overseeing all aspects of your care, both inpatient and outpatient.
All outpatient therapy is provided at the Yawkey Center for Cancer Care at Dana-Farber Cancer Institute, one of the most advanced outpatient cancer centers in the country.
If you need to be hospitalized during your care, or if you undergo stem cell transplantation, you will be admitted to Brigham and Women's Hospital (BWH) or the Dana-Farber Inpatient Hospital located within BWH. Your primary oncologist and nurse will closely monitor your care and will coordinate your care with the inpatient team and additional specialists, who will address any other symptoms you may be experiencing. This model ensures seamless care from the outpatient to the inpatient setting. Learn more about your stay.
