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It accounts for approximately 15% of newly diagnosed cases of leukemia in adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Diagnosis<\/jats:title>\n                    <jats:p>\n                      CML is characterized by a balanced genetic translocation, t(9;22)(q34;q11.2), involving a fusion of the Abelson gene (\n                      <jats:italic>ABL1<\/jats:italic>\n                      ) from chromosome 9q34 with the breakpoint cluster region (\n                      <jats:italic>BCR<\/jats:italic>\n                      ) gene on chromosome 22q11.2. This rearrangement is known as the Philadelphia chromosome. The molecular consequence of this translocation is the generation of a\n                      <jats:italic>BCR\u2010ABL1<\/jats:italic>\n                      fusion oncogene, which in turn translates into a BCR\u2010ABL oncoprotein.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Frontline therapy<\/jats:title>\n                    <jats:p>Four tyrosine kinase inhibitors (TKIs), imatinib, nilotinib, dasatinib, and bosutinib are approved by the United States Food and Drug Administration for first\u2010line treatment of newly diagnosed CML in chronic phase (CML\u2010CP). Clinical trials with second generation TKIs reported significantly deeper and faster responses, but they had no impact on survival prolongation, likely because of the existence of highly effective salvage therapies for patients who have a cytogenetic relapse with frontline TKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Salvage Therapy<\/jats:title>\n                    <jats:p>For CML post failure on frontline therapy, second\u2010line options include second and third generation TKIs. Although potent and selective, these exhibit unique pharmacological profiles and response patterns relative to different patient and disease characteristics, such as patients\u02bc comorbidities, disease stage, and BCR\u2010ABL1 mutational status. Patients who develop the T315I \u201cgatekeeper\u201d mutation display resistance to all currently available TKIs except ponatinib. Allogeneic stem cell transplantation remains an important therapeutic option for patients with CML\u2010CP who have failed at least 2 TKIs, and for all patients in advanced phase disease. Even among older patients who have a cytogenetic relapse post failure on all TKIs, they can maintain long\u2010term survival if they continue on a daily most effective\/less toxic TKI, with or without the addition of non\u2010TKI anti\u2010CML agents (hydroxyurea, omacetaxine, azacitidine, decitabine, cytarabine, busulfan, others).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajh.25792","type":"journal-article","created":{"date-parts":[[2020,4,2]],"date-time":"2020-04-02T09:06:45Z","timestamp":1585818405000},"page":"691-709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":379,"title":["Chronic myeloid leukemia: 2020 update on diagnosis, therapy and monitoring"],"prefix":"10.1002","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4465-6119","authenticated-orcid":false,"given":"Elias","family":"Jabbour","sequence":"first","affiliation":[{"name":"Department of Leukemia The University of Texas M. D. 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