Chronic Myeloid Leukaemia Treatment in Delhi

A diagnosis of Chronic Myeloid Leukaemia may feel frightening, but here’s the truth: CML is one of the most treatable blood cancers today. With modern targeted therapy, most patients live normal, full lives, going to work, raising families, and pursuing their dreams. Under expert care from Dr. Satyendra Katewa, a leading paediatric haemato-oncologist and CML specialist, patients achieve excellent long-term control with minimal disruption to daily life.

Chronic myeloid leukaemia treatment has been transformed by breakthrough medications that target the disease at its genetic root, making CML a success story in modern medicine.

What Is Chronic Myeloid Leukaemia?

Chronic myeloid leukaemia (CML) is a type of blood cancer that develops slowly in your bone marrow, the spongy tissue inside bones where blood cells are made. Unlike acute leukaemias that progress rapidly, CML develops gradually over months or years.

In CML, your bone marrow produces too many white blood cells that don’t work properly. These abnormal cells crowd out healthy blood cells, but the process happens slowly enough that many people feel completely well when first diagnosed.

What Makes CML Different?

CML is caused by a specific genetic abnormality called the Philadelphia chromosome. This isn’t inherited; it happens by chance when two chromosomes swap genetic material. This swap creates an abnormal gene called BCR-ABL, which acts like a faulty “on switch” telling your bone marrow to keep producing white blood cells nonstop.

The good news: Because we know exactly what causes CML, we have medications that specifically target this abnormality. These targeted therapies have transformed CML from a life-threatening disease into a manageable chronic condition for most patients.

Understanding CML Stages: The Three Phases

Unlike many cancers, CML stages aren’t numbered I through IV. Instead, doctors describe three phases based on how many abnormal cells are in your blood and bone marrow, and how well you feel.

Chronic Phase CML (85-90% of patients at diagnosis)

This is the earliest stage when most people are diagnosed. You might feel perfectly well or have only mild symptoms. Your blood tests show increased white blood cells, but blast cells (the most immature cells) are less than 10%.

The key point: With proper treatment started in the chronic phase, over 90% of patients achieve long-term remission and near-normal life expectancy. This is why early diagnosis matters so much.

Accelerated Phase CML

If chronic phase CML isn’t treated or doesn’t respond to treatment, it may progress to accelerated phase. Blast cells increase to 10-19%, symptoms become more noticeable, and the disease becomes harder to control. This affects about 5-10% of patients.

Treatment changes: More intensive targeted therapy combinations or consideration of bone marrow transplant may be needed.

Blast Phase CML (Blast Crisis)

This is the most advanced stage, where CML behaves more like acute leukaemia. Blast cells exceed 20%, causing severe symptoms and complications. With modern treatment starting early, very few patients progress to this stage.

Important message: Starting treatment in the chronic phase and taking medications regularly prevents progression to accelerated or blast phases in the vast majority of patients.

Recognising Chronic Myeloid Leukaemia Symptoms

Here’s what makes CML tricky: many people have no symptoms at all when diagnosed. The disease is often discovered during routine blood tests done for other reasons.

When CML Does Cause Symptoms

Fatigue that’s different: Not the usual tired after a busy day, but profound exhaustion where simple tasks feel overwhelming. You might need to rest after showering or climbing one flight of stairs.

Feeling full quickly: Your spleen (an organ under your left ribs) enlarges in CML, pressing on your stomach. You might feel full after a few bites of food or feel uncomfortable fullness in your left upper abdomen.

Unintentional weight loss: Losing weight without trying, despite eating normally.

Low-grade fever: Feeling slightly warm or having mild fevers without infection.

Night sweats: Drenching sweats that soak your clothes or sheets during sleep.

Easy bruising or bleeding: Though less common in chronic phase CML than in acute leukaemias.

Bone pain: Aching discomfort, particularly in your ribs or breastbone.

CML in Children: What Parents Should Watch For

Chronic myeloid leukaemia is rare in children but does occur. Early symptoms of CML in children may include:

• A child who used to love playing football now wants to sit and watch
• Complaining their tummy feels full even at breakfast
• Unexplained fevers that come and go
• Unusual tiredness that doesn’t improve with rest
• Losing weight despite eating normally

Important: These symptoms can have many causes. Most tired, full, or feverish children don’t have leukaemia. But if symptoms persist beyond 2-3 weeks or you notice several together, see a paediatric blood cancer specialist for evaluation.

What Causes Chronic Myeloid Leukaemia?

The honest answer: we don’t fully know the causes of chronic myeloid leukaemia. The Philadelphia chromosome that causes CML develops by chance; it’s not inherited from parents, and you can’t pass it to your children.

Known Risk Factors

Radiation exposure: High-dose radiation exposure increases risk. This includes atomic bomb survivors or people who received radiation therapy years ago. Modern diagnostic X-rays and CT scans pose minimal risk.

Age: CML can occur at any age, but is most common between 50-60 years. It accounts for only 2-3% of childhood leukaemias.

Gender: Slightly more common in males than females.

What Doesn’t Cause CML

• It’s not contagious; you can’t catch it from another person
• It’s not caused by lifestyle, diet, exercise, stress, or environmental exposures, which don’t cause the Philadelphia chromosome
• It’s not hereditary in most cases; having a family member with CML doesn’t significantly increase your risk
• Chemical exposure links are unclear, unlike in AML

The bottom line: In the vast majority of cases, CML happens by chance. There’s nothing you did or didn’t do that caused it.

How Is CML Diagnosed?

CML diagnosis includes:

The First Clue: Blood Test

Most people discover they have CML through a routine CML blood test (complete blood count) done for another reason. The test shows:

• Elevated white blood cell count (often very high, 50,000-500,000 compared to normal 4,000-11,000)
• Cells at different maturity stages (not just mature cells)
• Usually normal or slightly low red blood cells and platelets initially

Confirming the Diagnosis

Bone marrow examination: Taking a small sample from your hip bone examines cells in detail and confirms a chronic myeloid leukaemia diagnosis.

Philadelphia chromosome testing: The gold standard for CML diagnosis. Tests include:

• Cytogenetics: Looks for the Philadelphia chromosome under a microscope
• FISH testing: A more sensitive method to detect the chromosome
• PCR test: Detects the BCR-ABL mutation at the molecular level, this becomes crucial for monitoring treatment response

Additional tests: Liver and kidney function, imaging if spleen enlargement is suspected.

At Dr. Satyendra Katewa’s centre in Delhi, chronic myeloid leukaemia diagnosis follows internationally recognised guidelines, ensuring accuracy and appropriate treatment planning.

Is CML Curable? Understanding Your Outlook

The question everyone asks: “Is CML curable?”

Here’s the nuanced answer: With modern targeted therapy, most patients achieve what we call “deep molecular remission”, BCR-ABL levels become so low they’re nearly undetectable. Many patients maintain this remission for decades, living normal lifespans.

Some patients eventually stop treatment under careful monitoring (called treatment-free remission) and remain in remission. Is this a “cure”? Perhaps, though we monitor carefully for any return of disease.

The practical reality: With proper treatment, life expectancy with chronic myeloid leukaemia now approaches that of people without CML. The long-term survival rate of CML exceeds 90% at 10 years for patients diagnosed in the chronic phase and treated with modern targeted therapy.

What Influences Your Outcome?

CML outcomes depends on multiple factors like:

Phase at diagnosis: Chronic phase has excellent outcomes; accelerated or blast phase requires more intensive treatment.

Age and overall health: Younger, healthier patients tolerate treatment better, though CML is very treatable across all ages.

Response to treatment: Achieving early molecular milestones (measured by PCR test) predicts excellent long-term outcomes.

Medication adherence: Taking your targeted therapy daily as prescribed is absolutely crucial for success.

Genetic factors: Additional chromosomal changes beyond the Philadelphia chromosome may affect treatment response.

Chronic Myeloid Leukaemia Treatment

The story of CML treatment is one of medicine’s greatest success stories. Before 2001, bone marrow transplant was the only potential cure available to a few patients. Then came tyrosine kinase inhibitors (TKIs), targeted pills that specifically block the abnormal BCR-ABL protein.

CML Targeted Therapy: How It Works?

Think of the BCR-ABL protein as a faulty switch stuck in the “on” position, telling your bone marrow to keep making white blood cells. CML tyrosine kinase inhibitors are like perfectly fitted covers that block that switch, stopping the abnormal signal.

These medications don’t kill leukaemia cells directly like chemotherapy, they specifically target the molecular abnormality causing CML, leaving healthy cells largely unaffected.

First-Line TKI Options

Imatinib (Gleevec): The original breakthrough drug, still widely used. Taken once daily, it achieves excellent remission rates with manageable side effects. Generic versions have made it more affordable.

Dasatinib (Sprycel): More potent than imatinib, achieves deeper, faster remissions. Taken once daily.

Nilotinib (Tasigna): Another potent option, taken twice daily on an empty stomach.

Bosutinib (Bosulif): Alternative first-line or second-line option.

Your doctor chooses based on your CML characteristics, age, other medical conditions, and medication side effect profiles. There’s no single “best” TKI, the right choice varies for each patient.

Second and Third-Line Options

If your CML doesn’t respond adequately to first-line treatment or you develop resistance:

Ponatinib (Iclusig): Very potent TKI effective against resistant CML, including T315I mutation.

Asciminib: Newest TKI with a different mechanism, approved for resistant CML.

Having multiple effective medications means we can find the right fit for virtually every patient.

CML Treatment Without Chemotherapy

Unlike acute myeloid leukaemia treatment or acute lymphoblastic leukaemia treatment, most patients with chronic myeloid leukaemia never need traditional chemotherapy. Targeted therapy alone usually controls the disease excellently.

Chemotherapy might be used only in:

• Very rare cases of blast phase CML
• Bridge therapy before bone marrow transplant
• Very specific situations are decided by your oncology team

This means CML treatment typically involves:

• One or two pills daily
• Regular monitoring of blood tests
• Outpatient visits every 3-6 months
• Continuing normal life, work, and activities

Managing Side Effects of CML Targeted Therapy

Common but manageable side effects:

Muscle cramps and bone pain: Especially with imatinib. Usually improves with magnesium supplements, stretching, and dose adjustments if needed.

Nausea: Taking medication with food helps. Anti-nausea medications are available if needed.

Diarrhoea: Usually mild and manageable with diet adjustments or medication.

Fluid retention: Mild swelling around the eyes or ankles, particularly with imatinib. Rarely requires medication changes.

Rash: Mild skin reactions usually resolve or improve over time.

Fatigue: Often improves as your blood counts normalise.

Less common but important side effects:

Liver enzyme elevation: Monitored with regular blood tests. Usually asymptomatic and resolves with dose adjustment.

Low blood counts: Temporary, especially in the first months. Monitored closely.

Lung or heart issues: Rare but important to watch for. Dasatinib can cause fluid around the lungs in some patients; nilotinib may affect the heart in those with cardiac risk factors.

The key message: Most side effects are manageable. Don’t stop medication without discussing it with your doctor. We can adjust doses, switch medications, or add supportive treatments to help you tolerate therapy comfortably.

When Is Bone Marrow Transplant Needed for CML?

With effective targeted therapy available, when is BMT needed in CML? Much less frequently than in the past.

Bone marrow transplant for CML is now considered in:

Resistance to multiple TKIs: If your CML doesn’t respond to two or more different targeted therapies.

Blast phase CML: Advanced stage requiring intensive treatment.

T315I mutation: Some resistant mutations respond to ponatinib, but a transplant may be considered in certain situations.

Patient preference: Some younger patients with excellent donor matches may opt for transplant, hoping fora  cure, though this is increasingly rare given excellent TKI results.

Important: Over 90% of chronic phase CML patients never require a transplant. Targeted therapy alone controls the disease excellently for most people.

Monitoring Your CML

Living with chronic myeloid leukaemia means regular monitoring to ensure treatment is working. The PCR test (polymerase chain reaction) measures tiny amounts of BCR-ABL genetic material in your blood, tracking treatment response with remarkable precision.

Treatment Response Milestones

By 3 months: BCR-ABL should drop to ≤10% (baseline is 100%)

By 6 months: Should reach ≤1% (called major molecular response)

By 12 months: Should reach ≤0.1% (deep molecular response)

Achieving these milestones predicts excellent long-term outcomes. If you’re not hitting targets, your doctor may adjust treatment.

How Often Will You Need Tests?

First year: PCR test every 3 months

After achieving stable deep remission, PCR test every 3-6 months

Bone marrow tests: Usually only needed at diagnosis and if there’s concern about treatment response

Regular blood counts: Every 1-3 months, depending on your situation

This monitoring ensures your CML remains controlled and catches any problems early when they’re most treatable.

CML Remission and Follow-Up Care

Achieving CML remission means your blood counts are normal and BCR-ABL levels are very low or undetectable. Most patients maintain remission for many years with continued targeted therapy.

Treatment-Free Remission: Can You Stop Medication?

After maintaining deep molecular remission for several years (typically 3-5 years with BCR-ABL undetectable), some patients can stop medication under very careful monitoring. About 50% remain in remission without treatment.

Requirements for attempting treatment-free remission:

• At least 3-5 years of deep molecular remission
• Regular monitoring with a PCR test every 4-6 weeks initially
• Commitment to restarting treatment immediately if BCR-ABL reappears
• Close follow-up with your CML specialist

Important: Never stop medication without discussing with your doctor. Attempting treatment-free remission requires careful planning and monitoring.

Long-Term Survivorship

With modern treatment, you should expect to:

• Live a normal lifespan
• Work, exercise, and enjoy activities
• Have children (discuss timing with your doctor)
• Travel (just remember to pack medication!)
• Pursue your life goals

CML treatment success rate is so high that most patients shift from thinking “I have cancer” to “I manage a chronic condition”, similar to how people manage diabetes or high blood pressure.

Why Choose Dr. Satyendra Katewa for CML Treatment?

As a leading paediatric haemato-oncologist and recognised CML specialist, Dr. Satyendra Katewa provides expert, compassionate care for both children and adults with chronic myeloid leukaemia.

Expertise in CML Management

• Extensive experience managing chronic myeloid leukaemia across all age groups
• Expert in targeted therapy selection and optimisation
• Skilled in monitoring with PCR test and treatment adjustment
• Access to the latest tyrosine kinase inhibitors, including the newest agents
• Guidance on treatment-free remission when appropriate

Specialised Paediatric CML Care

Chronic myeloid leukaemia treatment in children requires special expertise. Dr. Katewa provides:

• Age-appropriate treatment protocols
• Growth and development monitoring
• Family-centred care and education
• School integration support
• Transition planning to adult care when appropriate

Comprehensive, Personalised Approach

Trusted doctor for CML treatment in Delhi means more than medical expertise, it means:

• Taking time to explain your diagnosis and treatment options clearly
• Shared decision-making respecting your values and preferences
• Accessible care when you have concerns or questions
• Coordination with other specialists when needed
• Support for your entire family

Transparent About Costs

CML treatment cost in India varies based on which targeted therapy is used and whether generic or brand-name medications are prescribed. Dr. Katewa provides:

• Clear discussion of treatment costs upfront
• Guidance on accessing generic medications when appropriate
• Help connecting with government schemes and patient assistance programmes
• Treatment decisions based purely on medical need, never cost

“My commitment is ensuring every patient with CML receives the targeted therapy they need to live a long, healthy life, regardless of their financial situation.” – Dr. Satyendra Katewa

International Patient Support

Dr. Satyendra Katewa welcomes international patients seeking CML treatment in Delhi:

Medical visa assistance, transparent cost estimates, pre-arrival consultation, airport pickup, accommodation recommendations, interpreter services, and online follow-up after returning home. CML treatment in India offers world-class care at significantly lower costs than in Western countries, particularly for long-term medication expenses.

Living Your Best Life with CML

Chronic myeloid leukaemia is no longer the devastating diagnosis it once was. With daily medication, regular monitoring, and expert care, you should expect to:

• Continue your career or studies
• Exercise and stay active
• Have and raise children
• Travel and pursue hobbies
• Live well into old age

Most of your days won’t involve thinking about CML at all, you’ll simply take your pill, live your life, and visit your doctor periodically to confirm everything remains well controlled.

Book Your Consultation

If you’ve been diagnosed with chronic myeloid leukaemia or have concerning symptoms, you may schedule a consultation with Dr. Satyendra Katewa, a trusted paediatric blood cancer specialist in Delhi.

What to bring:

• Recent blood test results
• Any bone marrow or genetic test reports
• List of current medications
• Questions you want to discuss

You’ll receive:

• Clear explanation of your diagnosis
• Discussion of targeted therapy options
• Personalised treatment plan
• Honest, realistic outlook
• Support throughout your journey

Early diagnosis and proper medical care can significantly improve long-term outcomes and quality of life.

References

• National Comprehensive Cancer Network (NCCN) Guidelines for CML
• European LeukemiaNet (ELN) Recommendations for CML Management
• Indian Council of Medical Research (ICMR) Haematology Protocols
• National Medical Commission (NMC) Guidelines
• British Committee for Standards in Haematology (BCSH) Guidelines