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Until recently, treatment for chronic myeloid leukemia and chronic lymphoblastic leukemia meant a hospital stay, intravenous chemotherapy and sometimes a stem cell transplant.

Now, thanks to research and clinical trials, chronic leukemia can often be controlled with a daily pill taken at home. ¡°We can treat these diseases in the same way we treat a chronic condition like hypertension or diabetes now,¡± says leukemia specialist

Depending on your diagnosis, you may be prescribed a targeted therapy drug like BCR-ABL1 inhibitors, BTK inhibitors, or BCL2 inhibitors. These have been shown to be very effective, but successful treatment means you may have to take a pill a day for the rest of your life.

Skipping pills can increase chances of a leukemia recurrence

While there are benefits to this approach, Jabbour says there are also challenges, especially in helping patients stay on their recommended treatment plans.

¡°When you¡¯re in the hospital, you have a whole care team monitoring your medication,¡± he says. ¡°But with maintenance therapy, it¡¯s up to you.¡± He adds that often patients ¨C especially younger patients ¨C feel healthy and well enough that they forget or decide not to take their medicine as directed.

¡°Skipping even three pills a month could cause you to relapse,¡± Jabbour says, citing a showing 50% of patients who relapse weren¡¯t taking their prescriptions.

That¡¯s why Jabbour works with patients to make sure they understand what to expect from maintenance therapy ¨C and how to overcome the challenges of managing medications independently at home.

Know what to expect with maintenance therapy for chronic leukemia

A cancer diagnosis is overwhelming, and it can be hard to fully understand your treatment plan. That¡¯s why Jabbour says it¡¯s important to read and understand the informed consent ¨C and to have an open conversation with your care team.

¡°I work with patients to go over everything they can expect from these drugs, from the serious side effects to the smaller ones. That way, they¡¯re not surprised,¡± Jabbour says.

Taking a daily pill may not seem like a huge task to keep cancer at bay, but there are things to keep in mind. For example, you¡¯ll need to stop drinking alcohol and avoid medications that may interact and make the maintenance therapy less effective. ¡°Making these lifestyle changes can be hard, but we will work with you to help you stay on track,¡± Jabbour says.

Small changes can help manage chronic leukemia maintenance therapy side effects

Side effects are a big reason patients may decide to stop taking their cancer medications. Knowing about side effects in advance will help you manage them ¨C and know what to expect.

For example, some patients may experience severe diarrhea for the first few days after starting a new drug. With the help of over-the-counter anti-diarrhea medication, these symptoms will improve, Jabbour says, so you won¡¯t have to change your dosage.

Fatigue is another common side effect, but changing the time you take your medicine may help. ¡°If you feel tired after taking medicine in the morning, try taking it at night instead,¡± Jabbour says. The same can be said for nausea.

If you¡¯re supposed to take your medicine on an empty stomach, try waiting until just before bedtime. ¡°Sometimes minor changes like this can make a big difference,¡± Jabbour says. 

Your care team may suggest adjusting your dosage if side effects are still bothering you after you¡¯ve made these changes. 

When to pause your prescription medications

There are certain times when you can¡¯t or shouldn¡¯t take your medicine. This could be the case if, for example, your pharmacy doesn¡¯t have your refill ready in time.

You also may need to pause your prescription if you¡¯re undergoing certain dental procedures or surgeries. ¡°Bleeding is a common side effect of these drugs. So, to prevent complications, we wouldn¡¯t want you to take them the day before a dental procedure, or even longer before surgery,¡± Jabbour says.

If you do find yourself in a situation like this, it¡¯s important to talk to your care team to be sure you¡¯re monitored closely after skipping a dose. ¡°Let your oncologist know any time you¡¯re having treatments like this so we can set up follow-up appointments and be aware of any signs of disease progression,¡± Jabbour says.  

Talk to your doctor about other medications

For women of childbearing age, it¡¯s important to consider birth control before starting maintenance therapy  to prevent getting pregnant, since chemotherapy can be dangerous for unborn children.

Whenever you take other medications, whether it¡¯s birth control pills or antibiotics, let your care team know so they can help prevent drug interactions. ¡°Your regular doctor may not be aware of the possible drug interactions. But your oncologist is,¡± Jabbour says.

Treatment options after chronic leukemia relapse

Unfortunately, if chronic myeloid leukemia and chronic lymphoblastic leukemia come back, they¡¯re more aggressive and usually harder to treat. You may have to undergo a stem cell transplant, which requires months of pre-transplant treatment, including multiple daily drugs to suppress your immune system.

And, Jabbour says, stem cell transplants are more successful when a patient is in minimal disease status than when they have aggressive advanced disease

Jabbour stresses that  good communication with your care team can increase your chances of success with long-term maintenance therapy and stave off the need for more aggressive treatments for as long as possible.

¡°I tell patients: ¡®I will do everything I can to help you succeed,¡¯¡± Jabbour says. ¡°There¡¯s no problem without a solution.¡±

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