Side Effects

Chronic myeloid leukemia (CML) treatment can sometimes produce side effects. Most patients can manage their side effects without stopping therapy.

Before you start treatment, talk with your doctor about potential side effects. Drugs and other therapies can prevent or manage many side effects. Many treatment side effects go away or become less noticeable over time.

Side Effects of Tyrosine Kinase Inhibitor (TKI) Therapy 

Imatinib mesylate (Gleevec®)

Common side effects include:

  • Nausea, vomiting and/or diarrhea
  • Muscle cramps and bone pain
  • Fatigue
  • Rashes
  • Edema (fluid retention)

Although rare, serious side effects of imatinib include:

  • Low blood cell counts which can put a patient at increased risk for anemia, infection and/or bleeding 
  • Congestive heart failure (impaired ability of the heart to pump blood) and left ventricular dysfunction (impaired functioning of the left side of the heart), particularly in patients with other health issues and risk factors. Patients with heart disease or risk factors for heart disease should be monitored and treated for the condition.
  • Severe liver problems

Dasatinib (Sprycel®)

Common side effects include:

  • Nausea
  • Diarrhea
  • Headache
  • Fatigue
  • Shortness of breath
    • Usually due to fluid in the lungs known as "pleural effusion" 
  • Rash
  • Fever

Serious side effects include: 

  • Low blood cell counts which can put a patient at increased risk for anemia, infection and/or bleeding 
  • Fluid retention around the lungs (pleural effusion) or the heart. Patients should call the doctor immediately if they have any of the following symptoms: swelling all over the body, weight gain, shortness of breath, and cough (especially during low levels of physical activity or at rest), or chest pain when taking a deep breath. 

In rare instances, dasatinib may increase the risk of developing a serious condition called “pulmonary arterial hypertension” (PAH), which is high blood pressure in the arteries of the lungs.

Doctors should check the heart and lungs of patients both before and during treatment with dasatinib. If a patient is diagnosed with PAH while taking dasatinib, the medication should be discontinued permanently. PAH may be reversible after dasatinib is discontinued.

Nilotinib (Tasigna®)

Common side effects include:

  • Nausea, vomiting, diarrhea
  • Rash
  • Headache
  • Fatigue
  • Itching
  • Cough
  • Constipation
  • Muscle and joint pain
  • Runny or stuffy nose, sneezing, sore throat
  • Fever
  • Night sweats

Serious side effects include:

  • Low blood cell counts which can put a patient at increased risk for anemia, infection and/or bleeding 
  • QT interval prolongation, a serious heart problem that causes a change in heartbeat rhythm - This condition can be fatal, and patients should contact their doctor immediately if they feel lightheaded, faint or have an irregular heartbeat while taking nilotinib. Before starting nilotinib and during treatment with nilotinib, doctors should check patients’ hearts with a test called an “electrocardiogram” (ECG, also abbreviated EKG).
  • Blood clots or blockages in the blood vessels, which can cause decreased blood flow to the legs, heart or brain 
  • Liver damage symptoms, including yellow skin and eyes (jaundice)
  • Pancreatitis (inflammation of the pancreas) 
  • Hyperglycemia, a higher than normal amount of glucose (sugar) in the blood 
  • Fluid retention with symptoms including shortness of breath, rapid weight gain, and swelling

Bosutinib (Bosulif®)

Common side effects include:

  • Stomach pain, diarrhea, nausea and/or vomiting
  • Fluid retention
  • Rash
  • Fatigue

Serious side effects include:

  • Low blood cell counts which can put a patient at increased risk for anemia, infection and/or bleeding 
  • Liver problems
  • Fluid retention around the lungs, heart and stomach
  • Kidney problems

Ponatinib (Iclusig®)

Common side effects include:

  • Rash
  • Stomach-area (abdomen) pain
  • Fatigue
  • Headache
  • Dry skin
  • Fever
  • Constipation
  • High blood pressure

Serious and/or life-threatening risks include:

  • Low blood cell counts which can put a patient at increased risk for anemia, infection and/or bleeding 
  • Blood clots or blockages in blood vessels (arteries and veins). Patients should get medical help right away if they have any of the following symptoms: chest pain or pressure; pain in the arms, legs, back, neck or jaw; shortness of breath; numbness or weakness on one side of the body; leg swelling; headache; severe stomach pain; dizziness; decreased vision or loss of vision; and/or trouble talking.
  • Heart problems including heart failure; irregular, slow or fast heartbeats; and heart attack. Doctors will check patients’ heart function, both before and during treatment with ponatinib. Patients with cardiovascular risk factors should be referred to a cardiologist. Get medical help right away if you get any of the following symptoms: shortness of breath, chest pain, fast or irregular heartbeats, dizziness, or feeling faint.
  • Liver problems including liver failure. Symptoms may include yellowing of the skin or white part of the eyes (jaundice), dark-colored urine, bleeding or bruising, loss of appetite and sleepiness.

Other serious side effects include:

  • High blood pressure
  • Pancreatitis (inflammation of the pancreas)
  • Neuropathy (damage to the nerves in the arms, brain, hands, legs or feet)
  • Serious eye problems that can lead to blindness or blurred vision
  • Severe bleeding
  • Fluid retention

Asciminib (Scemblix®)

Common side effects include: 

  • Upper respiratory tract infections 
  • Musculoskeletal pain
  • Fatigue 
  • Nausea
  • Rash
  • Diarrhea 

Serious side effects and/or life-threatening risks include:

  • Low blood cell counts. The healthcare team will check your blood cell counts every 2 weeks for the first 3 months of treatment and then monthly or as needed. Tell the healthcare team if you notice unexpected bleeding or bruising, blood in your urine or stool, fever, or signs of infection.
  • Pancreatitis (inflammation of the pancreas)
  • High blood pressure (hypertension)
  • Allergic reaction.
  • Heart and blood vessel (cardiovascular) problems. This drug can cause heart problems including heart attack, stroke, blood clots, blockage of arteries, heart failure and abnormal heartbeat. Tell the healthcare team right away if you have any of the following symptoms: shortness of breath, chest pain or pressure, a feeling like your heart is beating too fast or you feel abnormal heartbeats, swelling in your ankles or feet, dizziness, weight gain, numbness or weakness on one side of your body, decreased vision or loss of vision, trouble talking, headache, severe stomach-area pain, or pain in your arms, legs, back, neck, or jaw.

For information about the drugs listed on this page, visit Drug Listings.

Other Side Effects

Drugs such as omacetaxine mepesuccinate (Synribo®), interferon and hydroxyurea (Hydrea®) are sometimes used to treat CML patients. Side effects may include:

  • ​Low red blood cell, white blood cell and platelet counts
  • Diarrhea
  • Nausea
  • Fatigue
  • Fever
  • Infection
  • Reaction at the injection site.
  • Trouble with concentration and memory
  • Mood changes
  • Flu-like symptoms such as muscle aches, fatigue, fever, chills, headaches, nausea and vomiting 

Click here to learn more about the side effects of specific drugs. 

Graft-Versus-Host Disease

If you undergo allogeneic stem cell transplantation, you're at high risk of developing graft versus host disease (GVHD). The older you are, the higher your risk for GVHD. GVHD develops when the donor's immune cells mistakenly attack the patient's normal cells. GVHD can be mild, moderate or severe - even life threatening.

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