A diagnosis of chronic myeloid leukemia (CML) can be overwhelming. There's a lot to learn about this rare cancer and its treatments. There are many ways your life may change. But you and your health care team should approach it together. They need to know how you’re really feeling, so don’t keep questions to yourself. Speaking up helps you to participate in a treatment option that may be right for you.

You are the best advocate for yourself. This Doctor Discussion Guide can help you start a conversation about your needs and what's right for you.

What is CML?

CML is a cancer of the blood and bone marrow. Bone marrow is a sponge-like tissue in the center of most bones and is responsible for creating different types of blood cells.

A “good” cancer?

For more than 20 years, medications have helped make CML more manageable for many people. Thanks to advances in treatment, most people who have CML can anticipate having a life expectancy that’s close to normal.

CML has 3 phases

CML can be diagnosed in chronic phase, accelerated phase, or blast phase. Most adults with CML are diagnosed in the chronic phase. Your health care team may talk to you about the importance of keeping CML from progressing from the chronic phase to the more advanced accelerated or blast phases. If CML is left untreated, it is more likely to progress.

What causes CML?

CML occurs when the blood-forming cells of bone marrow mistakenly creates too many white blood cells. These damaged white blood cells crowd out healthy red blood cells, white blood cells, and platelets.

More than 95% of people with CML are diagnosed with Ph+ CML

Philadelphia chromosome–positive chronic myeloid leukemia (Ph+ CML) is caused by an abnormal fusion gene called BCR::ABL1, which results from a change in chromosomes in the body.

• Each cell in the human body has 23 pairs of chromosomes, and in CML, pieces of chromosomes 9 and 22 break off and trade places

• This can create a new abnormal chromosome: the Philadelphia (Ph+) chromosome

• This abnormal chromosome then produces the defective BCR::ABL1  gene, which makes an abnormal protein called BCR-ABL
   

Your health care team may want you to go for blood tests at specific time points such as every 3 months to see if you are responding to your medication. Tests may include:

An increase in your BCR::ABL1  levels can be a red flag for your health care team. That’s why it’s important to go for any blood tests prescribed and discuss what your results mean.

Not all CML treatments are the same—or work the same way. Most people with CML are treated with tyrosine kinase inhibitors (TKIs). TKIs are thought to work by helping to block the BCR-ABL protein that leads to the uncontrolled growth of leukemic cells.

Start on a CML medication you may be able to stay with

It's important to set a clear treatment plan from the start. Work with your health care team to find a treatment that combines effectiveness with side effects that may be manageable for you. Use this Doctor Discussion Guide to talk about your treatment options.