Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Cancer Care

Fremont and San Leandro Medical Centers


Chronic myelogenous leukemia (CML) is a type of blood cancer that involves myeloid cells that exist in the bone marrow. Myeloid cells are young cells that ultimately develop into white blood cells, red blood cells, and platelets.

CML is 1 of 4 main types of leukemia and affects about 5,000 adults in the United States each year. It is also called chronic myeloid leukemia and chronic granulocytic leukemia.

CML is divided into 3 phases based on the amount of immature blood cells in the bone marrow and blood, as well as the severity of your symptoms. Knowing the CML phase helps us plan the best treatment for you. There are more details about phases in the Diagnosis section of this article. 

After we have learned everything we can about your leukemia, we will discuss the treatment options and develop a plan that is right for you. Options for treating CML include targeted therapy, immunotherapy, chemotherapy, and stem cell transplantation.

Targeted Therapy

Targeted therapy is a relatively new approach to treating cancer. It involves the use of drugs that target specific proteins in or on the cancer cell. These proteins often stimulate or cause the cancer to grow. By inhibiting (shutting down) the activity of these proteins we can treat cancer effectively.

In CML, an abnormal gene, known as BCR-ABL, forms when genetic material from two chromosomes switch places and form a new chromosome called the Philadelphia chromosome. BCR-ABL expresses a protein, called tyrosine kinase, that activates and promotes survival of CML cells. Drugs known as tyrosine kinase inhibitors block this protein from working, causing CML cells to die.

CML is the first cancer that was found to be effectively treated with a targeted therapy. This initial targeted therapy medication is called imatinib (Gleevec).

There are currently 5 tyrosine kinase inhibitors available for CML. You will likely take a targeted drug for many years. If the drug you are on stops working, you may receive one of the other tyrosine kinase inhibitors.

These drugs are taken as a pill. They are very effective when taken continuously as prescribed.

Targeted Therapy Side Effects

Because targeted drugs take aim specifically at cancer cells, there is less collateral damage to healthy cells. Therefore, patients have less side effects compared with those who undergo traditional chemotherapy. But those targeted drugs still have some side effects, which may include:

  • Fluid buildup, which can cause swelling or bloating.
  • Muscle cramps.
  • Nausea.
  • Diarrhea.
  • Rash.

These drugs may also decrease your blood counts and cause problems involving the heart, lungs, and liver and increase risk for blood clots, so we will watch you closely. Let us know as soon as you notice any problems.

Many medicines can interact with tyrosine kinase inhibitors. These interactions can make treatment less effective or increase the amount of drug in your blood to dangerous levels.

Please let us know if you are taking any medicines, including over-the-counter drugs and supplements, and notify us before you start any new medicine. Acetaminophen (Tylenol) and St. John’s wort are commonly used medications that should be avoided. You should also avoid drinking grapefruit juice.


In some cases, CML stops responding to targeted drugs. We may then suggest a drug called interferon, which is given as an injection. Interferon is a type of immunotherapy, which means it uses your immune system to fight the cancer.

Side effects

Interferon causes symptoms similar to the flu, such as:

  • Fever
  • Chills
  • Fatigue
  • Muscle aches
  • Headaches

We can give you medicines to help treat the above side effects.


Chemotherapy is another option for treating some patients whose CML no longer responds to targeted drugs. These drugs enter the bloodstream and attack leukemia cells throughout the body. Chemotherapy may also be used before a stem cell transplant.

Side effects

Chemotherapy can cause a variety of side effects, the severity of which depends on the type and dose of the drug as well as the length of time it is given. You may experience one or more of the following common side effects of chemotherapy:

  • Hair loss.
  • Nausea and vomiting.
  • Loss of appetite.
  • Mouth sores.
  • Fatigue and shortness of breath (caused by low red blood cell counts).
  • Increased risk of infection (caused by low white blood cells counts).
  • Easy bleeding and bruising (caused by low platelet counts).

Low blood cell counts are a special concern because chemotherapy can cause dangerously low levels. We may give you drugs to boost your white blood cell counts, antibiotics to treat and prevent infections, and transfusions of red blood cells and platelets. We have effective methods for managing the various chemotherapy side effects, which typically go away once treatment ends.

Stem Cell Transplantation

On occasion, CML is treated with stem cell transplantation. A stem cell transplant wipes out the leukemia cells in the bone marrow (using high-dose chemotherapy or total body radiation), and replaces it with blood-forming stem cells from a donor creating a healthy environment for blood cell production.

Stem cells are usually obtained from the circulating blood but may also come from a newborn’s umbilical cord and placenta, which are rich in blood stem cells. Depending on the source of the stem cells, there are 2 main types of transplant:

  • Allogeneic transplant. Blood stem cells come from a related or unrelated donor whose genetics matches yours. The closer the match, the better the chance your body will accept the donor stem cells and start producing normal blood cells.
  • Autologous transplant. This type of transplant uses your own blood stem cells. However, we do not typically consider this type of transplant because it has not been found effective in CML.

Stem Cell Transplantation Side Effects

Treating the bone marrow with high-dose chemotherapy to prepare you for a stem cell transplant can temporarily leave your body without its natural defenses. It can take several months, and possibly more that a year for the bone marrow to fully recover. During that time, you are at an increased risk of infections and bleeding.

A complication of allogeneic (donor) stem cell transplantation is graft-versus-host disease (GVHD). This happens when the donor stem cells recognize your body as foreign and start attacking tissues of the skin, digestive tract, and liver. Other organs including the eye, muscle, and lungs may also be targets of GVHD. Symptoms of GVHD include:

  • Skin rash and contractures
  • Yellowing of the skin and eyes
  • Nausea
  • Diarrhea
  • Fatigue and weakness
  • Breathing difficulties

We will talk with you about what side effects to expect, and how we plan to prevent and manage them.

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