Chronic Myeloid Leukemia (CML)

Chronic myeloid leukemia (CML) is now managed for years with daily oral medicines called tyrosine kinase inhibitors (TKIs), and most people with CML have a near-normal life expectancy. Success is tracked with regular BCR-ABL blood tests. If your levels are not falling as expected, or side effects are hard to live with, our hematologist-oncologist can review your results and explain your options.

Medically reviewed by Dr. Muhammad Raza Naqvi, MD, USA board-certified hematologist-oncologist.

What is CML?

CML is a cancer of the bone marrow caused by a gene change called BCR-ABL1, usually from the Philadelphia chromosome. This gene makes an abnormal enzyme that drives the overproduction of white blood cells. CML is often found on a routine blood test showing a high white cell count.

Phases of CML

• Chronic phase: where most people are diagnosed; very treatable with TKIs.

• Accelerated phase and blast phase: more advanced and less common today because of effective treatment.

TKI treatment options

• Imatinib: the first TKI, still effective and widely used.

• Dasatinib, nilotinib and bosutinib: second-generation TKIs that often work faster.

• Asciminib: a newer drug that works in a different way; now approved for newly diagnosed and previously treated CML.

• Ponatinib: for resistant CML, including the T315I mutation.

The choice depends on your risk score, other health conditions, side effects and cost.

Understanding BCR-ABL results

BCR-ABL is measured by a PCR blood test, reported on the International Scale (IS). Key targets are 10 percent or less at 3 months, 1 percent or less at 6 to 12 months, and 0.1 percent or less (major molecular response) by 12 months. Missing these targets may mean a change in treatment or a mutation test.

Side effects and switching medicines

Common side effects include tiredness, muscle cramps, rash, stomach upset and fluid retention. Each TKI also has specific risks, such as effects on the heart, lungs or blood vessels. Switching to another TKI is common and often solves the problem.

Treatment-free remission

Some people with deep, stable responses for several years can stop their TKI under close monitoring. About half stay in remission without treatment.

How your 1-hour consultation works

• Book online and complete a short intake form.

• Upload your pathology, scan reports and lab results.

• Dr. Naqvi reviews your records before the visit.

• Meet by secure video for a full hour and leave with clear next steps and a written summary for your care team.

Frequently asked questions

Is CML curable?

Most people control CML for decades with TKIs. Some can stop treatment entirely (treatment-free remission).

How often do I need BCR-ABL tests?

Usually every 3 months until a stable deep response, then every 3 to 6 months.

Can I get a second opinion on my TKI?

Yes. We review your BCR-ABL history, side effects and other medicines to suggest options.