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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 murine leukemia (\n                      <jats:italic>ABL1<\/jats:italic>\n                      ) gene 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::ABL1<\/jats:italic>\n                      fusion oncogene, which in turn translates into a BCR::ABL1 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, dasatinib, bosutinib, and nilotinib, are approved by the United States Food and Drug Administration (FDA) for first\u2010line treatment of newly diagnosed CML in the chronic phase (CML\u2010CP). Clinical trials with second and third\u2010generation TKIs in frontline CML\u2010CP therapy reported significantly deeper and faster responses but had no impact on survival prolongation, likely because of their potent efficacy and the availability of effective TKIs salvage therapies for patients who have a cytogenetic relapse with frontline TKI therapy. All four TKIs are equivalent if the aim of therapy is to improve survival. In younger patients with high\u2010risk disease and in whom the aim of therapy is to induce a treatment\u2010free remission status, second\u2010generation TKIs may be favored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Salvage therapy<\/jats:title>\n                    <jats:p>\n                      For CML post\u2010failure on frontline therapy, second\u2010line options include second and third\u2010generation TKIs. Although potent and selective, these TKIs exhibit unique pharmacological profiles and response patterns relative to different patient and disease characteristics, such as patients' comorbidities and financial status, disease stage, and\n                      <jats:italic>BCR::ABL1<\/jats:italic>\n                      mutational status. Patients who develop the T315I \u201cgatekeeper\u201d mutation display resistance to all currently available TKIs except ponatinib, asciminib, and olverembatinib. Allogeneic stem cell transplantation remains an important therapeutic option for patients with CML\u2010CP and failure (due to resistance) of at least two TKIs and for all patients in advanced\u2010phase disease. Older patients who have a cytogenetic relapse post\u2010failure on all TKIs can maintain long\u2010term survival if they continue a daily most effective\/least toxic TKI, with or without the addition of non\u2010TKI anti\u2010CML agents (hydroxyurea, omacetaxine, azacitidine, decitabine, cytarabine, and others).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajh.27443","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:26:17Z","timestamp":1722590777000},"page":"2191-2212","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":220,"title":["Chronic myeloid leukemia: 2025 update on diagnosis, therapy, and monitoring"],"prefix":"10.1002","volume":"99","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 MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1908-3307","authenticated-orcid":false,"given":"Hagop","family":"Kantarjian","sequence":"additional","affiliation":[{"name":"Department of Leukemia The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"key":"e_1_2_14_2_1","unstructured":"American Cancer Society.Cancer Facts & Figures.2024. 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