Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for CML usually comes from a machine outside the body (external radiation therapy) is sometimes used to relieve symptoms or as part of therapy given before a bone marrow transplant.

Bone marrow transplantation is used to replace the patient's bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be an identical twin (the best match), a brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant.

Another type of bone marrow transplant, called autologous bone marrow transplant, is being tested in clinical trials. To do this type of transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is then frozen to save it. The patient is given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.

High-dose chemotherapy with stem cell transplantation is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

Donor lymphocyte infusion (DLI) is a cancer treatment that may be used after stem cell transplantation. Lymphocytes (a type of white blood cell) from the stem cell transplant donor are removed from the donor's blood and may be frozen for storage. The donor's lymphocytes are thawed if they were frozen and then given to the patient through one or more infusions. The lymphocytes see the patient's cancer cells as not belonging to the body and attack them.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

If the spleen is greatly enlarged, the spleen may be removed in an operation called a splenectomy.

Treatment by stage: Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered.

Chronic Phase CML: Treatment may be one of the following:

• High-dose chemotherapy with donor stem cell transplantation.
• Biological therapy (interferon) with or without chemotherapy.
• Other drug therapy (Gleevec).
• Chemotherapy to lower the number of white blood cells.
• Surgery to remove the spleen (splenectomy).
• A clinical trial of a new treatment.

Accelerated Phase CML: Treatment may be one of the following:

• Stem cell transplantation.
• Other drug therapy (Gleevec).
• Biologic therapy (interferon) with or without chemotherapy.
• High-dose chemotherapy.
• Chemotherapy to lower the number of white blood cells.
• High-dose chemotherapy.
• Transfusion therapy to replace red blood cells, platelets, and sometimes white blood cells, to relieve symptoms and improve quality of life.
• A clinical trial of a new treatment.

Blastic Phase CML: Treatment may be one of the following:

• Other drug therapy (Gleevec).
• Chemotherapy using one or more drugs.
• High-dose chemotherapy.
• Donor stem cell transplantation.
• Chemotherapy as palliative therapy to relieve symptoms and improve quality of life.
• A clinical trial of a new treatment.

Relapsed chronic myelogenous leukemia: Treatment may be one of the following:

• Donor stem cell transplantation.
• Donor lymphocyte infusion.
• Biologic therapy (interferon).
• A clinical trial of biologic therapy, combination chemotherapy, or other drug therapy (Gleevec).

The prognosis: The chance of recovery depends on a number of factors including the phase of CML, the amount of blasts in the blood or bone marrow, the size of the spleen at diagnosis, the patient's general health, and the patient's age.

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