[{"data":1,"prerenderedAt":103},["ShallowReactive",2],{"wiki-item-en-chronic-myeloid-leukemia":3,"media-slots-en":47},{"slug":4,"category":5,"categoryName":6,"title":7,"summary":8,"toc":9,"ymyl":32,"hasAlternate":46,"updatedAt":15},"chronic-myeloid-leukemia","blood","Hematologic Diseases","Chronic Myeloid Leukemia (CML)","Chronic myeloid leukemia (CML) is a cancer of the blood and bone marrow characterized by the BCR::ABL1 fusion gene. With tyrosine kinase inhibitor (TKI) therapy, many people with CML can achieve long-term disease control.",[10,16,20,24,28],{"key":11,"title":12,"html":13,"icon":14,"updatedAt":15},"","Overview","\u003Cp>\u003Cspan style=\"font-size: 15px;\">Chronic myeloid leukemia (CML) is a cancer of the blood and bone marrow in which abnormal myeloid cells grow and multiply excessively.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">CML can occur at any age but is most common in adults and is rare in children. Compared with acute leukemia, CML usually progresses more slowly. The disease is generally classified into \u003Cstrong>chronic phase, accelerated phase, and blast phase\u003C\u002Fstrong>, with most people diagnosed during the chronic phase.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">A defining feature of CML is the \u003Cstrong>Philadelphia chromosome (Ph chromosome) and the BCR::ABL1 fusion gene\u003C\u002Fstrong>. This genetic change is important for both diagnosing CML and selecting targeted treatment.\u003C\u002Fspan>\u003C\u002Fp>","⚕️","2026-09-14",{"key":11,"title":17,"html":18,"icon":19,"updatedAt":15},"Causes","\u003Cp>\u003Cspan style=\"font-size: 15px;\">The exact cause of CML is not known, but the key molecular changes that drive the disease are well understood.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Human cells normally contain 23 pairs of chromosomes. In the leukemia cells of most people with CML, genetic material is exchanged between chromosomes 9 and 22. This change is known as the \u003Cstrong>t(9;22) chromosomal translocation\u003C\u002Fstrong>.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">The translocation creates an abnormal chromosome 22 called the \u003Cstrong>Philadelphia chromosome\u003C\u002Fstrong> and forms the \u003Cstrong>BCR::ABL1 fusion gene\u003C\u002Fstrong>.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">The BCR::ABL1 fusion gene produces an abnormal tyrosine kinase that remains continuously active. This sends ongoing growth signals to myeloid cells, allowing them to multiply and survive when they normally would not. Over time, these abnormal cells build up in the blood and bone marrow and interfere with normal blood cell production.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">For most people, it is not known what causes this chromosomal change. CML is generally not an inherited disease passed from parent to child.\u003C\u002Fspan>\u003C\u002Fp>","🧬",{"key":11,"title":21,"html":22,"icon":23,"updatedAt":15},"Signs and Symptoms","\u003Cp>\u003Cspan style=\"font-size: 15px;\">Some people with CML have no symptoms when they are diagnosed, and the disease may be found during a routine physical exam or blood test. When symptoms occur, they may include:\u003C\u002Fspan>\u003C\u002Fp>\u003Cul class=\" list-paddingleft-2\" style=\"list-style-type: disc;\">\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Ongoing fatigue or weakness\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Fever\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Unexplained weight loss\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Loss of appetite\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Night sweats\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Pale skin\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Easy bleeding or bruising\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Pain, pressure, or fullness under the ribs on the left side\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003Cli>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Feeling full after eating only a small amount\u003C\u002Fspan>\u003C\u002Fp>\u003C\u002Fli>\u003C\u002Ful>\u003Cp style=\"margin-top:7px;margin-bottom:7px;margin-top:auto;margin-bottom:auto\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Fullness or discomfort in the upper left abdomen may be related to an \u003Cstrong>enlarged spleen\u003C\u002Fstrong>.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","📋",{"key":11,"title":25,"html":26,"icon":27,"updatedAt":15},"Diagnosis","\u003Cp>\u003Cspan style=\"font-size: 15px;\">If blood test results or symptoms suggest CML, additional tests may be performed to confirm the diagnosis and better understand the disease.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Blood Tests\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">A complete blood count (CBC) measures the number of different types of blood cells. People with CML often have a high white blood cell count and may also have abnormalities in other blood cell counts.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Bone Marrow Tests\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Bone marrow aspiration and biopsy may be used to examine the number, appearance, and other characteristics of cells in the bone marrow and provide additional information for diagnosis and disease assessment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003C\u002Fh3>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Philadelphia Chromosome and BCR::ABL1 Testing\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Tests such as chromosome analysis, fluorescence in situ hybridization (FISH), and polymerase chain reaction (PCR) can be used to detect the Philadelphia chromosome or the BCR::ABL1 fusion gene.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">BCR::ABL1 testing is important not only for diagnosing CML but also for monitoring treatment response over time.\u003C\u002Fspan>\u003C\u002Fp>","🩺",{"key":11,"title":29,"html":30,"icon":31,"updatedAt":15},"Treatment","\u003Cp>\u003Cspan style=\"font-size: 15px;\">The main goals of CML treatment are to suppress BCR::ABL1-positive leukemia cells, achieve long-term disease control, and reduce the risk of disease progression.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">The development of tyrosine kinase inhibitors (TKIs) has transformed CML treatment. For most people with chronic-phase CML, a TKI is the main treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Tyrosine Kinase Inhibitors (TKIs)\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">TKIs work by blocking the abnormal tyrosine kinase produced by the BCR::ABL1 fusion gene, interrupting signals that help CML cells grow and survive.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Several TKIs are available for CML, including \u003Cstrong>imatinib, dasatinib, nilotinib, bosutinib, ponatinib, and asciminib\u003C\u002Fstrong>.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">The choice of TKI depends on several factors, including the phase of CML, BCR::ABL1 mutation status, response to previous treatment, age, other health conditions, and the potential side effects of each medication.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">If treatment is not working as expected, resistance develops, or side effects become difficult to manage, the treatment plan may be adjusted.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Treatment Monitoring\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">During TKI treatment, \u003Cstrong>BCR::ABL1 levels are monitored regularly\u003C\u002Fstrong> to evaluate how well the leukemia is responding to treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Changes in BCR::ABL1 levels over time help assess treatment response and guide decisions about whether to continue or adjust therapy.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Treatment-Free Remission (TFR)\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Some people who have maintained a deep molecular response for a sustained period may be able to try stopping TKI therapy under close medical supervision. This is known as \u003Cstrong>treatment-free remission (TFR)\u003C\u002Fstrong>.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">TFR is not appropriate for everyone. People who stop treatment need frequent BCR::ABL1 monitoring, particularly during the early period after stopping therapy. If molecular relapse occurs, TKI treatment usually needs to be restarted.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">TKI therapy should not be stopped without discussing it with the treating healthcare team.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cstrong style=\"font-size: 15px;\">Hematopoietic Stem Cell Transplantation (HSCT)\u003C\u002Fstrong>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">With the effectiveness of TKI therapy, hematopoietic stem cell transplantation is no longer the first treatment for most people with chronic-phase CML.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">An \u003Cstrong>allogeneic hematopoietic stem cell transplant (allo-HSCT)\u003C\u002Fstrong> may be considered for selected patients whose CML does not respond adequately to TKIs, develops certain forms of drug resistance, or progresses to accelerated or blast phase.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Allogeneic HSCT offers the possibility of a cure but also carries significant risks, including graft-versus-host disease (GVHD) and serious infections. The decision depends on the disease status, response to previous treatments, age, overall health, and donor availability.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Chemotherapy\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">With the widespread use of TKIs, traditional chemotherapy now has a limited role in chronic-phase CML.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">In some situations, particularly when CML progresses to blast phase, chemotherapy may be combined with a TKI or other treatments.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong> Clinical Trials\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">Clinical trials study new treatments, treatment combinations, and new ways of using existing therapies for CML.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cspan style=\"font-size: 15px;\">For people who are not responding adequately to treatment, develop resistance, or need additional treatment options, discussing available clinical trials with the healthcare team may be helpful.\u003C\u002Fspan>\u003C\u002Fp>","💊",{"author":11,"reviewedBy":11,"lastReviewed":11,"datePublished":11,"citations":33,"disclaimer":11},[34,37,40,43],{"title":35,"url":36},"National Cancer Institute (NCI). Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version.","https:\u002F\u002Fwww.cancer.gov\u002Ftypes\u002Fleukemia\u002Fpatient\u002Fcml-treatment-pdq",{"title":38,"url":39},"National Cancer Institute (NCI). Chronic Myelogenous Leukemia Treatment (PDQ®)–Health Professional Version.","https:\u002F\u002Fwww.cancer.gov\u002Ftypes\u002Fleukemia\u002Fhp\u002Fcml-treatment-pdq",{"title":41,"url":42},"American Cancer Society (ACS). Chronic Myeloid Leukemia (CML).","https:\u002F\u002Fwww.cancer.org\u002Fcancer\u002Ftypes\u002Fchronic-myeloid-leukemia.html",{"title":44,"url":45},"Leukemia & Lymphoma Society (LLS). 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