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Previous advice to switch the tyrosine kinase inhibitor (TKI) on failure of molecular milestones, is modified to better account for individual patient circumstances. Our recommendations are summarized in tables designed to be read in conjunction with the text which offers justification and additional advice. We describe decision-making for first-line treatment, both in available drugs and their initial dosing. Similarly we elaborate on dose reduction rather than drug switching to manage toxicities and discuss treatment sequencing. Data have matured for the outcome of treatment discontinuation and for management of parenting for both men and women. We acknowledge that most patients will remain on treatment for many years and emphasize the needs to minimize side effects, manage co-morbidities and optimize quality of life. Recent advances in allogeneic stem cell transplantation have broadened access to alternative donors, and lessened limitations of age and co-morbidities such that transplant remains a valuable option for patients for whom long-term disease control is not achieved through TKI therapy.<\/jats:p>","DOI":"10.1038\/s41375-025-02664-w","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T06:55:49Z","timestamp":1752216949000},"page":"1797-1813","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":164,"title":["2025 European LeukemiaNet recommendations for the management of chronic myeloid leukemia"],"prefix":"10.1038","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1710-1794","authenticated-orcid":false,"given":"Jane F.","family":"Apperley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragana","family":"Milojkovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5481-2555","authenticated-orcid":false,"given":"Nicholas C. 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DM received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Enliven, Incyte, Novartis and Terns, and institutional research support from Ascentage, Incyte and Pfizer. NCPC received honoraria for advisory boards\/consultancies\/speakers bureau from Blueprint and Novartis, and institutional research support from Novartis. HHH received honoraria for advisory boards\/consultancies\/speakers bureau from Incyte and institutional research support from Austrian Orphan, BMS\/Celgene, Incyte and Pfizer. AH received honoraria for advisory boards\/consultancies\/speakers bureau from Enliven, Incyte and Novartis and institutional research support from BMS, Enliven, Incyte, Novartis, Pfizer and Terns. HK received honoraria for advisory boards\/consultancies\/speakers bureau from AbbVie, Amgen, Ascentage, Takeda, Novartis and Pfizer and institutional research support from AbbVie, Amgen, Ascentage, BMS\/Celgene, Daiichi Sankyo, Ipsen Biopharmaceuticals, Immunogen, KAHR Medical, Novartis, Shenzhen Target Rx and Stemline. JHL received honoraria for advisory boards\/consultancies\/speakers bureau from Takeda and Pfizer. HM received honoraria for advisory boards\/consultancies\/speakers bureau from Astra Zeneca, BARD India, Cipla, Eli Lilly, NATCO, Omnicuris, Novartis, Pfizer and Roche. DN has no disclosures. JR has no disclosures. PR received institutional research support from Incyte and Pfizer. SSa received honoraria for advisory boards\/consultancies\/speakers bureau from Incyte, Novartis, Roche and Zentiva and institutional research support from BMS\/Celgene, Incyte and Novartis. CAS has no disclosures. RTS has no disclosures. SSo received honoraria for advisory boards\/consultancies\/speakers bureau from Incyte and Novartis. LS received institutional research support from Xspray Pharma. AT received honoraria for advisory boards\/consultancies\/speakers bureau from Novartis, Pfizer and R Pharm. LFC received honoraria for advisory boards\/consultancies\/speakers bureau from Incyte, Novartis and Pfizer. FCa received honoraria for advisory boards\/consultancies\/speakers bureau from BMS\/Celgene, Incyte, Novartis, Pfizer and Zentiva and institutional research support from BMS\/Celgene, Incyte, Novartis and Pfizer. FCe has no disclosures. REC has no disclosures. JC received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Biopath Holdings, Enliven, Takeda, Janssen, Syndax, Novartis, Pfizer, SunPharma and Terns and institutional research support from Ascentage, Cyto agents, Takeda, Kuro Oncology, Novartis, SunPharma and Terns. MD received honoraria for advisory boards\/consultancies\/speakers bureau from Blueprint, Cogent, Takeda, Novartis and Pfizer and institutional research support from Terns. TPH received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Enliven, Takeda, Novartis and Terns and institutional research support from Novartis. JJ received institutional research support from BMS\/Celgene and Novartis. QJ received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage and Novartis. DWK received honoraria for advisory boards\/consultancies\/speakers bureau from Enliven, ILYANG, Novartis, Terns Pharma: RAL, CVS\/Caremark, Daiichi Sankyo, Epizyme\/Ipsen, Takeda and Novartis, and institutional research support from BMS\/Celgene, Enliven, ILYANG, Takeda, Novartis, Otsuka and Terns. RAL received institutional research support from Ascentage, Astellas, Biomea Fusion, Cellectis, Daiichi Sankyo and Novartis. FXM received honoraria for advisory boards\/consultancies\/speakers bureau from Incyte and Novartis. MJM received honoraria for advisory boards\/consultancies\/speakers bureau from AbbVie, BMS, Enliven, Takeda, Novartis, Pfizer and Terns, and institutional research support from BMS\/Celgene, Enliven, Takeda, Novartis and Terns. JM received institutional research support from BMS\/Celgene and Novartis. FEN received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, BMS\/Celgene, GSK, Incyte, Kumquat sciences Inc, Novartis and Terns and institutional research support from Incyte and Novartis. FP received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, BMS\/Celgene, Incyte, Novartis and Pfizer. DR received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Enliven, Incyte, Novartis and Terns. JRi has no disclosures. GR received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Incyte, Novartis and Pfizer. GS received honoraria for advisory boards\/consultancies\/speakers bureau from Ascentage, Enliven, Hikma and Novartis. RH has no disclosures","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}