Managing the Side Effects of My CML Medicines

This article is for patients who have newly diagnosed or relapsed/refractory (R/R) chronic myeloid leukemia (CML) or anyone who wants to learn more about CML. The goal is to teach patients with CML how to work with their healthcare team to manage side effects of tyrosine kinase inhibitor (TKI) medicines.

You will learn:

• Treatment options for patients with newly diagnosed or R/R CML

• Potential benefits of TKIs when taken as prescribed

• Potential side effects of TKIs and how to manage them

• Questions for your healthcare team

• CML is a disease that affects your bone marrow (BM)

• BM is where stem cells are made; stem cells are immature cells that turn into different kinds of blood cells

• In CML, some of your stem cells change into abnormal cells, called leukemia cells, that don't mature the way they should

• They also divide faster than normal and don't die when they should, leaving less room for normal blood cells

• They can also leave the BM, enter the blood, and travel through the blood to organs where they can keep other cells from working properly

• CML typically starts during or after middle age

• There are 3 phases of CML: chronic, accelerated, and blast

• Symptoms are mildest in the chronic phase and increase as patients progress through each phase

• Symptoms include fatigue, weight loss, fever, night sweats, and pain, or a feeling of fullness, below the ribs on the left side

• Some people with CML do not have any symptoms, especially during the early stages

Table 1

Chemotherapy	Uses medicines to kill fast-growing cells or stop fast-growing cells from multiplying in your body
High-dose chemotherapy with stem cell transplant	Used to kill your abnormal stem cells and replace them with healthy stem cells from a transplant
Donor lymphocyte infusion	Takes white blood cells (WBCs) from a healthy person and gives them to a patient after a stem cell transplant

Table 2

Biologic therapy (also called immunotherapy)	Boosts the patient's own immune system to help fight cancer cells
Splenectomy (surgery to remove the spleen)	Done to relieve symptoms of an enlarged spleen, which can sometimes occur in patients with CML
Targeted therapy	Uses medicines to attack specific cancer cells without harming normal cells. TKIs are a type of targeted therapy

• TKIs interrupt the process that helps cancer cells grow

• All cells have a life cycle: they grow, divide into more cells, communicate with one another, and eventually die

• Tyrosine kinases (TK) are proteins, called enzymes, that play a role in many of these cell functions

• Some types of cancer cells have too many TKs or overactive TKs that make them grow out of control

• Blocking TKs with TKIs may help keep cancer cells from growing or slow down their growth

• There are 5 TKIs available to treat CML:

  Imatinib (Gleevec®)

  Nilotinib (Tasigna®)

  Dasatinib (Sprycel®)

  Bosutinib (Bosulif®)

  Ponatinib (Iclusig®)

This program will focus on TKIs for CML in adults. Not all TKIs used to treat adults are suitable for children. If you have questions on which TKIs are appropriate for your child with CML, please ask your doctor

For adults with CML, your doctor will prescribe your TKI based on factors, such as:

• Your health history

• Side effects of the TKI

• Whether you have low-, intermediate-, or high-risk disease, which is based on your expected response to treatment and how your disease might progress

• Whether your CML is in the chronic-phase (CP), accelerated-phase (AP), or blast crisis (BC) phase

Imatinib is used to treat patients with a new diagnosis of CP CML. It can also be given to patients with CML in any phase who did not respond to interferon-alpha treatment

Dasatinib is used to treat adults with a new diagnosis of CP CML. It is also used to treat adults with CML in any phase who did not respond to their prior treatment, including imatinib, or were not able to tolerate the side effects

Nilotinib is given to patients with a new diagnosis of CP CML. It is also given to adults with CP and AP CML who did not respond to their prior treatment, including imatinib, or were not able to tolerate the side effects

Bosutinib is used to treat adults with a new diagnosis of CP CML. It is also given to adults with CML in any phase who did not respond to their prior treatment, including imatinib, or were not able to tolerate the side effects

Ponatinib is given to adults with CML in any phase who are not able to receive any other TKI or who have a specific genetic mutation (change in the DNA of cells)

• All TKIs are pills that are taken by mouth

• Taking your TKI the way it is prescribed each day will increase the chance that it will work

• Your doctor will talk with you about the best TKI for you, how often to take your pill, and if it should be taken with food

• Follow your doctor's instructions for taking your TKI

• Skipping pills or adjusting the dose can affect the way the TKI works, so you should not make any changes to the way you take your medicine without talking to your doctor about it

• There are some common side effects of TKIs that you should look out for, including:

  Diarrhea

  Fatigue

  Headaches

  Fevers

  Low blood counts

  Nausea and vomiting

  Changes in your skin, such as rash

  Fluid buildup in limbs or around certain organs

• You may also have uncommon, but severe or life-threatening side effects, like heart problems, liver problems, and kidney failure; your doctor will monitor you for signs of these side effects

• Not all side effects are listed here, so ask your healthcare team for a complete list of common and rare side effects of the TKI you are taking

• Continue taking your TKI, and tell your doctor or healthcare team immediately if you experience any side effects

• You and your doctor can work together to decide how best to manage your side effects

• Your doctor may decrease the dose or stop the TKI briefly to help with your side effects

• Your doctor may change you to a different TKI to help with your side effects

• Some side effects can be managed with medicines or lifestyle changes -- your doctor may discuss this with you

• Your doctor will do routine blood tests to watch for problems with your liver and low blood cell counts

• What should I do if I have side effects?

• What happens if my TKI stops working?

• What happens if I miss a dose of my TKI?

• Why do I need to take my TKI every day if I feel fine?

Congratulations!

 

You have successfully completed the program: Managing the Side Effects of My CML Medicines

View your Certificate of Completion.