Chronic Myelogenous Leukemia (CML) Treatment in India

Chronic Myelogenous Leukemia (CML) is a slow-progressing blood cancer driven by a genetic mutation called the Philadelphia chromosome. With early detection and modern oral therapies, most patients achieve long-term remission. India offers affordable, high-quality CML treatment using cutting-edge TKIs and transplant options. Monthly treatment in India starts from $800–$2,000, making it cost-effective for international patients.

What Is Chronic Myelogenous Leukemia (CML)?

Chronic Myelogenous Leukemia (CML) is a slow-progressing type of blood cancer that originates in the bone marrow and affects white blood cells. It causes the body to produce too many immature white blood cells, known as granulocytes.

CML typically affects adults over the age of 40, but it can also occur in younger individuals. With timely diagnosis and access to modern treatments, most patients can manage CML effectively for many years.

How Does CML Affect the Body?

CML begins in the bone marrow, where blood cells are produced. The condition results in excessive production of myeloid white blood cells, which do not mature properly and crowd out healthy cells.

A key feature of CML is the Philadelphia chromosome, a genetic mutation that creates the BCR-ABL gene, which triggers uncontrolled cell growth. This gene plays a central role in disease progression and guides treatment choices.

What Are the Types or Phases of CML?

CML progresses through three distinct phases:

Chronic Phase:

• Mild symptoms or none at all.
• Usually diagnosed at this stage.
• Responds well to treatment.

Accelerated Phase:

• Symptoms increase.
• Blood counts become harder to control.
• May require more aggressive treatment.

Blast Crisis:

• Resembles acute leukemia.
• Rapid cell growth.
• Requires urgent, intensive therapy.

The goal of treatment is to keep patients in the chronic phase or return them to it if progression occurs.

What Are the Causes and Risk Factors of CML?

While the precise cause of CML is unknown, the following factors may increase the risk:

• Genetic Mutations: Philadelphia chromosome and BCR-ABL gene fusion.
• Radiation Exposure: High-dose radiation may increase risk.
• Age and Gender: Most common in adults over 50; slightly more prevalent in men.
• No clear inheritance pattern has been found, and CML is not contagious.

What Are the Symptoms of CML?

In early stages, CML may not cause symptoms. When present, common signs include:

• Fatigue and weakness
• Unexplained weight loss
• Fever or night sweats
• Enlarged spleen (causing abdominal discomfort)
• Bone pain
• Frequent infections
• Shortness of breath
• Easy bruising or bleeding

If any of these symptoms are persistent, a blood test can provide early clues.

How Is CML Diagnosed?

CML diagnosis involves several steps:

• Complete Blood Count (CBC): Reveals elevated white blood cells.
• Peripheral Blood Smear: Examines blood cell morphology.
• Bone Marrow Biopsy: Confirms diagnosis and assesses disease stage.
• Cytogenetic Testing: Identifies the Philadelphia chromosome.
• Polymerase Chain Reaction (PCR): Detects BCR-ABL gene at a molecular leve

How Is CML Staged and Monitored?

CML is staged based on the number of immature white cells in the blood and marrow. Monitoring includes:

• PCR Testing: Tracks molecular response to treatment.
• Cytogenetic Analysis: Checks for chromosomal changes.
• Blood Counts: Ongoing monitoring of WBC, RBC, and platelet levels.
• Physical Exams: To check for spleen or liver enlargement.

What Are the Treatment Options for CML?

1. Tyrosine Kinase Inhibitors (TKIs):

• First-line therapy targeting BCR-ABL gene.
• Common TKIs include Imatinib, Dasatinib, Nilotinib, and Bosutinib.
• Most CML patients respond well to TKIs and may take them lifelong.

2. Chemotherapy:

• Used in resistant or advanced-phase cases.
• Less common now due to TKI success.

3. Bone Marrow or Stem Cell Transplant:

• Considered for younger patients or those not responding to TKIs.
• Offers potential cure but comes with risks.

4. Clinical Trials:

• Access to newer TKIs or immunotherapy agents under investigation.

What Devices Are Used in CML Treatment?

• Port-a-Cath or Central Line: For those undergoing chemotherapy or transplant.
• Infusion Pumps: To deliver medications during in-patient treatments.
• PCR Machines: For monitoring molecular remission levels.

What Are the Common Procedures Involved?

• Oral Therapy: Most TKIs are taken daily at home.
• Infusion Therapy: For chemo or monoclonal antibody treatment.
• Bone Marrow Transplant: Requires hospital stay, immune suppression, and donor matching.
• Regular Monitoring: Includes blood work and PCR every 3–6 months.

Why Is Early Treatment Important?

Early treatment prevents disease progression and:

• Helps maintain chronic phase status.
• Improves life expectancy.
• Reduces complications such as anemia, infections, and bleeding.
• Delays or avoids the need for bone marrow transplant.

What Are the Benefits of Modern CML Treatment?

• High response rates with minimal side effects.
• Molecular monitoring enables personalized care.
• Oral TKIs improve quality of life and independence.
• Prolonged remission and near-normal lifespan in many patients.

Why Is India a Preferred Destination for CML Treatment?

India offers:

• Globally accredited hospitals (JCI/NABH).
• Advanced molecular diagnostics and treatment options.
• Experienced hematologists and oncologists.
• Multilingual support for international patients.
• Significant cost savings over Western countries.

Why Choose Dr. Ankur Bahl?

Dr. Ankur Bahl is a trusted name in hematologic oncology and is known for:

• Expertise in chronic and acute leukemias.
• Over 15 years of experience in cancer care.
• Pioneering use of targeted therapies in India.
• Affiliation with leading Indian hospitals.
• Personalized, compassionate patient care.

What Is the Cost of CML Treatment in India?

Note: India offers up to 70% savings compared to the US and UK.

What Is the Long-Term Outlook for CML Patients?

With consistent TKI therapy and regular monitoring:

• Most patients maintain normal life expectancy.
• Regular PCR testing ensures early relapse detection.
• Lifelong medication may be required, though some may achieve treatment-free remission after years of successful therapy.

What Are the Success Rates for CML Treatment?

• Over 90% of patients in chronic phase achieve long-term remission with TKIs.
• Survival rates have improved drastically in the last two decades.
• Bone marrow transplant remains curative in select cases.