It may be daunting at first, but it is important to speak up and work closely with your health care team to discuss treatment goals. You can help determine an appropriate treatment plan from the start by voicing your questions and preferences. Some common goals include:

• Getting blood cell counts back within a normal range

• Reducing the number of leukemic cells in the body

• Reducing the amount of BCR-ABL protein in the body to an undetectable level

• Keeping chronic myeloid leukemia (CML) from progressing

See a CML specialist—even if only once

While your local doctor is someone you need to rely on, you may find it helpful to see a CML specialist. A specialist can work together with your local health care team to help guide your treatment.

Milestones are measured by the level of BCR::ABL1  gene in your blood. The illustrations below show different milestones and how the amount of BCR::ABL1  gene may decrease over time with treatment.

At diagnosis: At the time of a CML diagnosis, the abnormal BCR::ABL1  gene level in the blood is different for everyone. Your health care team will determine your BCR::ABL1  gene level at diagnosis, which will be your baseline level and typically will be considered as 100%. Your baseline level will be compared to future levels to determine whether you are reaching treatment milestones.

Early Molecular Response (EMR): With EMR, the level of BCR::ABL1  in the blood is between 10% and 1% at 3 to 6 months.

Complete Cytogenetic Response (CCyR): With CCyR, the level of BCR::ABL1  in the blood is ≤1%. Your health care team may say you have a CCyR if there are no Philadelphia chromosome-positive (Ph+) cells detected in the bone marrow.

Major Molecular Response (MMR): With MMR, the level of BCR::ABL1  in the blood is ≤0.1%.

Deep Molecular Response (DMR): MR4.0 or MR4.5: With DMR, the level of BCR::ABL1  in the blood is ≤0.01% (MR4.0) or ≤0.0032% (MR4.5).

Complete Molecular Response (CMR): With CMR, the level of BCR::ABL1  in the blood is undetectable.

If your BCR::ABL1  increases, or you do not achieve your CML treatment goals, you may want to ask your health care team about other treatment options.

The table below summarizes the milestones that may be achieved in response to treatment. Not all those living with CML can achieve these milestones or goals described.

Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Chronic Myeloid Leukemia V.1.2026. ©National Comprehensive Cancer Network, Inc. 2025. All rights reserved. Accessed July 16, 2025. To view the most recent and complete version of the guideline, go online to NCCN.org ↗. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Drug resistance may happen

One of the goals in treating CML is to see the number of leukemic cells in your blood decrease. For some people, this may not happen. If your numbers are going up, you may be experiencing drug resistance. There are 2 types of resistance in CML:

• Treatment doesn’t work: The body does not respond to treatment at all. This is known as primary drug resistance

• Treatment works at first, but stops: This is known as secondary drug resistance

That’s why it’s important to work with your health care team to find a treatment that may work and one you may be able to stay with.

Have side effects from your medication interfered with some of your daily activities? Don’t keep it to yourself. Your health care team needs to know.

Be sure to tell your health care team about anything you experience that may be a side effect, sign, or symptom, including how it may be interfering with your daily activities or your emotional health.

If side effects are becoming so bothersome that you’re not able to take your CML medication as prescribed, tell your health care team. Missing doses can make your medication less effective.

Being a “good patient” doesn’t have to mean putting up with side effects

Some people with CML feel they don’t want to bother their health care team by bringing up side effects. But in order for your health care team to provide you with the best treatment, they need to know how you are truly feeling.

CML requires teamwork. Your health care team knows medicine, but only you know how you feel when you take your CML medication. This Doctor Discussion Guide can help you start the conversation.