STEP 6: Managing relapsed or refractory disease


Most refractory or relapsed disease will be detected via a loss of molecular, cytogenetic or haematological response on routine monitoring.


When managing people with CML who have treatment failure or resistance, treatment will depend on the degree and timing of failure, mutation analysis, age, comorbidities and adherence and toxicity to prior TKIs.

Advance care planning

Advance care planning is important for those patients with advanced disease. It allows them to plan for their future health and personal care by thinking about their values and preferences. This can guide future treatment if the patient is unable to speak for themselves.

Palliative care

Palliative care should be addressed and offered for those with blast phase CML. Timely referral to palliative care can improve quality of life and in some cases may be associated with survival benefits. Referral should be based on need, not prognosis.


The lead clinician and team’s responsibilities include explaining the treatment intent, likely outcomes and side effects to the patient and/or carer and the patient’s GP.


  • Treatment intent, likely outcomes and side effects explained to the patient and/or carer and the patient’s GP
  • Supportive care needs assessed and referrals to allied health and community support services as required
  • Advance care planning discussed with the patient and/or carer as indicated
  • Patient referred to palliative care if appropriate
  • Routine follow-up visits scheduled