Therapeutic options in chronic myeloid leukaemia

The treatment of CML is unsatisfactory. Only bone marrow transplantation offers the possibility of cure. At present all other therapies are palliative and none has been shown to extend survival consistently. Busulphan and hydroxyurea remain the most widely used drugs for chronic phase. Intensive and non-intensive combination chemotherapy regimens have not produced significant improvement in survival. Interferon therapy is promising in patients who respond but requires further evaluation. Splenectomy does not improve survival but may be useful in selected circumstances. Extramedullary disease carries a poor prognosis and responds best to local treatment. The treatment of blast transformation is very difficult. The lymphoid variety should be recognised as response is better to appropriate treatment. Some Philadelphia (Ph) chromosome negative cases have disease which is probably identical to Ph positive disease and respond well to treatment. The others carry a very bad prognosis and respond poorly to treatment.