CML is highly treatable. However, as it is a chronic disease, most people will be on therapy (a TKI) for a minimum of several years, with treatment potentially continuing indefinitely. To gain benefit from TKI therapy, it is extremely important to take the pills daily as prescribed.
You should also continue to take any other prescription or over-the-counter medications as directed by your doctor. An inexpensive pill organizer (available at most drugstores) allows for the sorting of medications by day of week and time of day, which will help you take your medications on schedule. There are also free medication reminder apps available for smart phones or tablets.
Q: I am taking a TKI, but am experiencing side effects. What are my options?
A: For people who experience side effects on a TKI, there are other options—including a brief period off the drug, a dose reduction (either temporarily or for the long term) or a change to another TKI therapy. Any change must be carefully managed under the care of your cancer physician.
Q: Am I more susceptible to infections when being treated for CML?
A: In general, people with CML do not have an increased risk of infection, especially once the CML is in remission. However, both the disease itself and its treatment can impact immune function. When white blood cells are abnormally low (a condition called neutropenia), an infection may progress rapidly and become serious. For this reason, it’s important that people being treated for CML immediately report fevers or other signs of infection to their health care team. If neutropenia exists (or if advised by your cancer physician), you should avoid contact with those who have symptoms of a cold and should stay away from crowded places.
The risk of foodborne infection can be reduced by avoiding foods that easily spoil or become moldy without an obvious change in smell or appearance. This includes strawberries and raspberries and soft fruits that lack a thick peel. Undercooked ground beef, poultry and eggs should be avoided during treatment, as should buffets and salad bars.
Q: I’m taking a proton pump inhibitor for GERD. Could this reduce the effectiveness my prescribed TKI?
A: Acid-suppressive drugs such as proton pump inhibitors (PPIs) can reduce the absorption of TKIs into the bloodstream. This effect varies depending on the TKI and the type of acid-suppressive medicine being used. Talk to your cancer physician and the doctor who prescribed the PPI. They may recommend alternative strategies instead of a PPI, or recommend taking the PPI and the TKI several hours apart to minimize interactions.
Q: Should I get a flu shot while being treated for CML?
A: The Centers for Disease Control and Prevention (CDC) recommends seasonal flu shots for people being treated for any form of cancer, including CML. Flu shots are safe for people with compromised immune systems, as they’re made from an inactivated virus. The nasal mist form of the flu vaccine should not be taken, as it’s made from a live virus. It’s also important that family members and close companions of those receiving any type of cancer treatment get flu shots to prevent catching and passing on the flu.
On a related note, ask your doctor or a member of your health care team if you should continue to receive the vaccines recommended for your age and specific situation, such as those for pneumonia, shingles and herpes zoster.