Chronic Myeloid Leukemia: NCCN 2025 Guidance
CML is a BCR::ABL1-driven leukemia usually controlled long term with tyrosine kinase inhibitors, regular molecular monitoring, and specialist care.
Overview
Chronic myeloid leukemia (CML) is a blood cancer driven by the Philadelphia chromosome and BCR::ABL1 fusion gene. Most patients are diagnosed in the chronic phase.
Diagnosis And Workup
Initial evaluation includes a history and physical, complete blood count, chemistry panel, and bone marrow review. A quantitative test for BCR::ABL1 on the International Scale confirms the diagnosis.
Hepatitis B screening is recommended before starting therapy. Risk scoring helps guide the choice and intensity of treatment.
First-Line Treatment
Tyrosine kinase inhibitors (TKIs) are the standard first-line therapy. Hydroxyurea may be used briefly to lower very high white cell counts before a TKI begins.
Treatment is chosen considering age, comorbidities, possible drug interactions, and patient preference. Regular monitoring tracks response milestones.
Monitoring And Response
Blood counts are checked frequently at first, then as needed. Molecular testing measures BCR::ABL1 levels to confirm response and detect resistance early.
Mutational analysis guides changes in therapy when response is inadequate. Selected patients may later discuss treatment-free remission with their doctor.
Special Considerations
Allogeneic stem cell transplant is reserved for advanced-phase disease or cases resistant to available TKIs. During pregnancy, interferon-based therapy is generally preferred over TKIs.
