Supportive treatments for chronic myeloid leukaemia (CML)

Chronic myeloid leukaemia (CML) and its treatment can cause symptoms and problems. Supportive treatments can help to either prevent or control these problems.  

The problems or symptoms you have depend on how the CML is affecting your body. And it also depends on what treatment you have.

You might have treatments for the following problems:

High white blood cell count

You might have very high numbers of leukaemia cells in the blood when you are diagnosed with CML. This can cause problems with normal circulation.

The doctors will want to lower your blood cell count quickly. They might suggest you take a chemotherapy drug called hydroxyurea whilst they are waiting to find out what type of leukaemia you have. This drug lowers the number of leukaemia cells in your blood. This can help stop problems due to a high white blood cell count.

You gradually stop taking the hydroxyurea when you start your CML treatment.

Preventing tumour lysis syndrome

When cancer drugs kill leukaemia cells, the body breaks down the dead cells. This releases chemicals into your blood. So the normal balance of chemicals circulating in your blood suddenly changes. This is called tumour lysis syndrome.

You have regular blood tests to check for this if you are at risk. It’s important to drink plenty of fluids. Your doctor might also prescribe you a tablet to lower the risk of tumour lysis syndrome.

Treating infections

CML and its treatment affect your immune system. So you might be at risk of getting infections. But for most people, infections are not a common problem.

It’s important to tell your hospital treatment team urgently if you have any signs of infection.

Symptoms include:

• a change in temperature
• aching muscles
• headaches
• feeling cold and shivery and generally unwell

You might have other symptoms depending on where the infection is.

For some infections you can have treatment at home. But other infections can be life threatening, and you will need treatment in hospital.

Treatment for infection includes:

• antibiotics which treat bacterial infections
• antiviral drugs which treat viral infections
• antifungal drugs which treat infection caused by a fungal infection

Preventing infections

Vaccines

Vaccines are a way of protecting you against certain infections. Your doctor is likely to suggest that you have:

• a yearly flu vaccine
• a coronavirus (covid) vaccine

Blood products

Rarely, you might need to have a blood transfusion or platelet transfusion. This is because your bone marrow might not make enough red blood cells or platelets. This isn't a common problem for people with CML.

You should only have irradiated blood products following treatment with the chemotherapy drug fludarabine. The radiation kills any white cells in the blood products. This protects you from a rare reaction to the blood cells. You should carry a card or wear a bracelet to make doctors and nurses aware of this. This is important in case of an emergency.

Blood transfusion

A low red blood cell count is called anaemia. You can feel very tired and have little or no energy. You might also feel breathless when you move around. Your doctor will check your blood counts. 

You can have a blood transfusion if you are anaemic. This can help you to feel better.

Some people have a reaction to the blood, although this is rare. Tell your doctor or nurse if you feel hot or cold and shivery during the infusion. Your nurse will give you medicines to reduce the reaction.

Platelet transfusion

You might have low platelet levels. Platelets help the blood to clot. A low platelet level means you are at risk of bleeding. Tell your nurse or doctor straight away if you have any signs of unusual bleeding, such as:

• blood in your urine or when you have your bowels open
• bruises or tiny red spots on your skin
• nosebleeds

You might need a platelet transfusion. 

Some people have a reaction to the platelets. This can make you feel hot or very cold and shivery when you are having the transfusion. Tell your doctor or nurse if you have this. They will give you medicines to reduce the reaction.