Chronic myeloid leukaemia (CML)
Prepared with OnCo (onco.cc/prep/cml/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
16 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example BCR-ABL1 by RT-qPCR on the International Scale, ABL1 kinase-domain mutations, ELTS score at diagnosis, Additional cytogenetic abnormalities, Cardiovascular risk profile), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (chronic phase, first line), which of the standard options do you recommend and why?
- 6.Am I a candidate for Imatinib, Dasatinib, Nilotinib or related drugs, and what side effects should I expect?
- 7.For my situation (resistance or intolerance), which of the standard options do you recommend and why?
- 8.Am I a candidate for Ponatinib, Asciminib, Bosutinib, and what side effects should I expect?
- 9.For my situation (sustained deep molecular response), which of the standard options do you recommend and why?
- 10.For my situation (blast phase), which of the standard options do you recommend and why?
- 11.Am I a candidate for Ponatinib, Dasatinib, and what side effects should I expect?
- 12.Are there clinical trials I could join, for example of Asciminib, Allogeneic stem cell transplantation, Radotinib?
- 13.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 14.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 15.I read that “Blast-phase CML: median survival still under a year”. How does that affect my plan?
- 16.I read that “Predicting who can stop TKI safely; second TFR attempts”. How does that affect my plan?
The words I may hear
- Drug resistance (primary and acquired): Why cancer drugs stop working: the tumour either never depended on the target or evolves around the block.
- Oncogene addiction: When a cancer depends so completely on one mutated gene that blocking it collapses the tumour.
- Aneuploidy and chromosomal instability as the cause of cancer: The oldest theory of cancer, from Theodor Boveri in 1914: tumours arise from cells with the wrong number or arrangement of chromosomes.
- Somatic mutation theory of cancer: The standard account: cancer begins when a single body cell picks up mutations in the genes that control growth, and its descendants inherit them.
- Clonal evolution and the ecological view of cancer: A tumour is a population of cells that mutate, compete and are selected, exactly as species are, and treatment is one more selective pressure.
- Minimal / molecular residual disease (MRD): Cancer still present after treatment but too small to see on scans, detected by blood or marrow tests.
Tests and results to bring
Biomarker results to ask for: BCR-ABL1 by RT-qPCR on the International Scale (MMR = ≤0.1%, MR4.5 = ≤0.0032%), ABL1 kinase-domain mutations (T315I, F317L, E255K/V, Y253H), ELTS score at diagnosis, Additional cytogenetic abnormalities, Cardiovascular risk profile (drug selection).
Scans and tests linked to this cancer: Cytogenetics and FISH, MRD / molecular residual disease testing.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Chronic phase, first line: Imatinib 400 mg, or a second-generation TKI (dasatinib, nilotinib, bosutinib), or asciminib (ASC4FIRST, approved 2024). Choice by comorbidity and treatment goal; monitor BCR-ABL1 IS at 3, 6, 12 months against ELN milestones. (Imatinib, Dasatinib, Nilotinib, Bosutinib, Asciminib)
- Sustained deep molecular response: Treatment-free remission attempt after ≥3-5 years of TKI and ≥2 years of MR4 or better, with monthly PCR for the first six months (EURO-SKI); restart on loss of MMR. (Minimal / molecular residual disease (MRD))
- Blast phase: TKI plus acute-leukaemia-type induction (ponatinib or dasatinib with chemotherapy), then allogeneic HSCT. (Ponatinib, Dasatinib, Allogeneic stem cell transplantation)
- Resistance or intolerance: Switch TKI guided by mutation analysis; ponatinib or asciminib for T315I; allogeneic HSCT if two or more TKIs fail or in advanced phase. (Ponatinib, Asciminib, Allogeneic stem cell transplantation, Bosutinib)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.