Chronic myeloid leukaemia, chronic phase
Chronic-phase chronic myeloid leukaemia is the disease that imatinib turned from fatal into manageable: a daily pill blocks the BCR::ABL1 protein that drives it. Blood tests track the leukaemia gene to a millionth, newer pills such as asciminib (ASC4FIRST) reach deeper responses faster, and patients with years of undetectable disease can try stopping.
Overview
The Philadelphia chromosome, t(9;22), fuses BCR to ABL1 and produces a constitutively active tyrosine kinase; in chronic phase the marrow overproduces mature granulocytes with fewer than 10 percent blasts (WHO) and the disease is symptomless in half of patients, found on a routine blood count. Response is measured by quantitative PCR for BCR::ABL1 on the International Scale, with ELN milestones of 10 percent or less at three months, 1 percent or less at six months and 0.1 percent or less (major molecular response) at twelve months; failure to reach them prompts kinase domain mutation testing and a switch of drug.
IRIS (2003) randomised 1,106 newly diagnosed patients to imatinib or interferon plus cytarabine: complete cytogenetic response at 18 months in 76 percent versus 14 percent, and at ten years 83 percent of imatinib patients were alive, most without progression. Second-generation inhibitors dasatinib (DASISION), nilotinib (ENESTnd) and bosutinib (BFORE) produce faster and deeper responses without a survival advantage, at the cost of pleural effusions, vascular events and liver toxicity respectively. Asciminib, which binds the myristoyl pocket rather than the ATP site, beat investigator-selected inhibitors in ASC4FIRST (2024): major molecular response at 48 weeks in 67.7 percent against 49.0 percent, and 69.3 percent against 40.2 percent for imatinib, with fewer side effects, earning accelerated approval for newly diagnosed disease in October 2024.
Resistance through kinase domain mutations is handled by switching: ponatinib or asciminib for T315I, and the third-generation olverembatinib in China; allogeneic transplant is reserved for failure of several inhibitors. Treatment-free remission is now a goal: EURO-SKI found about half of patients with at least three years of therapy and a year of deep molecular response stayed in remission two years after stopping. The unsolved problems are the residual stem cell pool that keeps the other half relapsing, cardiovascular toxicity over decades of therapy, and the price and access gap that leaves patients in low-income countries on older drugs or none.
State of the art
- Asciminib gives the highest first-line molecular response rates yet reported with the fewest side effects.
- About half of patients who reach a deep, stable response can stop treatment and stay in remission.
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- Life expectancy in chronic-phase CML on tyrosine kinase inhibitors approaches that of the general population.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowFainting or palpitations
Fainting, near-fainting, or an irregular or racing heartbeat; several kinase inhibitors prolong the QT interval and the labels require ECG and electrolyte monitoring.
- Check before combiningDasatinib with Nilotinib: major interaction
QT: both Dasatinib and Nilotinib prolong the QT interval (known and known risk).. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
- Check before combiningFood and drink: Asciminib
Take on an empty stomach.
- Check before combiningFood and drink: Bosutinib
Take with food.
- Check before combiningFood and drink: Imatinib
Take with a meal and a large glass of water.
- Check before combiningFood and drink: Nilotinib
Take on an empty stomach (no food 2 hours before or 1 hour after): food raises exposure up to 82% and QT risk.
See all on the product pages:AsciminibBosutinibDasatinibImatinibNilotinibOlverembatinibPonatinibRadotinib·Printable cards in the navigator
Anatomy and lymph node drainage
- Bone marrow (leukaemia, MDS, MPN, myeloma)
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- Nodes: cervical
- Nodes: axillary
- Nodes: mediastinal
- Nodes: para-aortic and mesenteric
- Nodes: inguinal
Leukaemias, myeloma and MDS live in the marrow and blood; lymphomas grow in lymph nodes and spleen. The node stations are the disease map, not a route of spread, and staging counts them.
- Bone marrow (leukaemia, MDS, MPN, myeloma)Newly diagnosed chronic phase, low ELTS risk · Newly diagnosed chronic phase, high ELTS risk · Chronic phase resistant or intolerant to first tyrosine kinase inhibitor · Chronic phase with T315I mutation (ponatinib, asciminib, olverembatinib) · Chronic phase in sustained deep molecular response (treatment-free remission candidate) · Chronic phase in pregnancy or in children
- Lymph node germinal centre (lymphomas)
- Spleen
- Blood (leukaemic phase)
- Lytic bone lesions (myeloma)
- Skin and extranodal sites
- cervical
- axillary
- mediastinal
- para-aortic and mesenteric
- inguinal
In lymphoma the node stations are the disease itself; staging (Ann Arbor / Lugano) counts how many regions and sides of the diaphragm are involved.
Same organ: Marginal zone lymphoma, Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome), Primary mediastinal (thymic) large B-cell lymphoma, Leukaemia (all types), Acute myeloid leukaemia, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Chronic myeloid leukaemia (CML), Diffuse large B-cell lymphoma, Follicular lymphoma, Hodgkin lymphoma, Mantle cell lymphoma, Multiple myeloma, Non-Hodgkin lymphoma (all types), Myelodysplastic syndromes / neoplasms (MDS), Myeloproliferative neoplasms (PV, ET, myelofibrosis), Polycythaemia vera (PV), Essential thrombocythaemia (ET), Waldenström macroglobulinaemia, Hairy cell leukaemia, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Blastic plasmacytoid dendritic cell neoplasm (BPDCN), Burkitt lymphoma, HIV-associated (AIDS-related) lymphomas, Chronic myelomonocytic leukaemia and MDS/MPN overlap neoplasms, Systemic mastocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and other histiocytic neoplasms, Langerhans cell histiocytosis (LCH), Post-transplant lymphoproliferative disorder (PTLD), FLT3-mutated acute myeloid leukaemia, IDH1- and IDH2-mutated acute myeloid leukaemia, NPM1-mutated and KMT2A-rearranged acute myeloid leukaemia, Secondary and therapy-related acute myeloid leukaemia, Acute promyelocytic leukaemia, Acute myeloid leukaemia in older or unfit patients, Smouldering multiple myeloma, Newly diagnosed multiple myeloma, transplant-eligible, Newly diagnosed multiple myeloma, transplant-ineligible, Relapsed or refractory multiple myeloma, Plasma cell leukaemia, Lower-risk myelodysplastic syndromes, Higher-risk myelodysplastic syndromes, Chronic lymphocytic leukaemia, first treatment, Relapsed or refractory chronic lymphocytic leukaemia, Richter transformation of chronic lymphocytic leukaemia, Chronic myeloid leukaemia, accelerated and blast phase, Primary myelofibrosis
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- About 95 percent of people with chronic myeloid leukaemia are diagnosed in chronic phase; on a tyrosine kinase inhibitor their life expectancy is close to that of the general population, and about half of those who reach a deep, stable molecular response can stop treatment.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Imatinib 400 mg daily, a second-generation inhibitor (dasatinib, nilotinib, bosutinib) chosen by comorbidity and treatment goal, or asciminib (ASC4FIRST); PCR at 3, 6 and 12 months against ELN milestones.
Switch inhibitor guided by kinase domain mutation testing; ponatinib or asciminib for T315I; radotinib or olverembatinib where approved; allogeneic transplant after failure of two or more inhibitors.
Attempt treatment-free remission after at least three to five years of therapy and two years of MR4 or better, with monthly PCR for six months; restart on loss of major molecular response.
Subtypes & biomarkers
top- Newly diagnosed chronic phase, low ELTS risk
- Newly diagnosed chronic phase, high ELTS risk
- Chronic phase resistant or intolerant to first tyrosine kinase inhibitor
- Chronic phase with T315I mutation (ponatinib, asciminib, olverembatinib)
- Chronic phase in sustained deep molecular response (treatment-free remission candidate)
- Chronic phase in pregnancy or in children
- BCR ::ABL1 transcript by quantitative PCR on the International Scale
- ELTS and Sokal risk scores
- Karyotype and additional chromosomal abnormalities
- BCR ::ABL1 kinase domain mutations (T315I and others)
- Depth of molecular response (MR4, MR4.5) for stopping
- Cardiovascular risk profile before nilotinib or ponatinib
How often this target appears
- 1960Nowell and Hungerford describe the Philadelphia chromosome
- 1990BCR-ABL shown to cause leukaemia in mice
- 1998Imatinib enters the clinic: remissions in nearly every chronic-phase patient
- 2003IRIS: imatinib beats interferon plus cytarabine
- 2006Dasatinib and nilotinib approved for resistant disease, later first line
- 2012Ponatinib approved, covering T315I
- 2018EURO-SKI: half of patients stopping treatment stay in remission
- 2024ASC4FIRST: asciminib approved for newly diagnosed chronic phase
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 11 changes by month →- 2026-09-17This recordChronic myeloid leukaemia, chronic phaseFacts on this page last checked
When this page itself was last checked or edited.
- 2024MilestoneAsciminibASC4FIRST: asciminib approved for newly diagnosed chronic phase
A milestone in how this cancer is treated.
- 2018MilestoneMolecular response (MMR, MR4, treatment-free remission)EURO-SKI: half of patients stopping treatment stay in remission
A milestone in how this cancer is treated.
- 2017ApprovalBosutinibBosutinib approved in US
Newly diagnosed Ph+ CML chronic phase
- 2012MilestonePonatinibPonatinib approved, covering T315I
A milestone in how this cancer is treated.
- 2010ApprovalNilotinibNilotinib approved in US
Newly diagnosed Ph+ CML chronic phase
What is in development for Chronic myeloid leukaemia, chronic phase, drawn from the whole corpus: 6 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Drugs in phase 3 · 1
Trials under way · 5
- A Study of Oral Asciminib Versus Other TKIs in Adult Patients With Newly Diagnosed Ph+ CML-CP · phase 3 · Novartis Pharmaceuticals
- A Study to Investigate Tolerability and Efficacy of Asciminib (Oral) Versus Nilotinib (Oral) in Adult Participants (≥18 Years of Age) With Newly Diagnosed Philadelphia Chromosome Positive Chronic Myelogenous Leukemia in Chronic Phase (Ph+ CML-CP) · phase 3 · Novartis Pharmaceuticals
- Study of Olverembatinib (HQP1351) in Patients With CML-CP · phase 3 · Ascentage Pharma Group Inc.
- A Phase 1/2 Clinical Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Efficacy of TERN-701 in Participants With Chronic Myeloid Leukemia (CARDINAL) · phase 1/2 · Terns, Inc., a subsidiary of Merck & Co., Inc. (Rahway, New Jersey USA)
- A Phase 3 Study for the Efficacy and Safety of Radotinib in CP-CML Patients With Failure or Intolerance to Previous TKIs · phase 3 · Il-Yang Pharm. Co., Ltd.
Open problems and what is being done
The leukaemic stem cells that survive kinase inhibition and cause relapse after stopping.
and how the field plans to fix it →What is being done about thisRecurrence and residual diseaseAvailable nowIn trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Background: Minimal / molecular residual disease (MRD). Also on OnCo: Treatment journeys · Survivorship planner.
Cardiovascular toxicity over decades on second- and third-generation inhibitors.
and how the field plans to fix it →What is being done about thisSide effects and quality of lifeAvailable now- Allogeneic stem cell transplantationStandard of care
- BosutinibApproved
- NilotinibApproved
In trials- A Phase 1/2 Clinical Study to Evaluate the Safety, Tolerability, Pharmacokinetics, and Efficacy of TERN-701 in Participants With Chronic Myeloid Leukemia (CARDINAL)Recruiting
- A Study to Investigate Tolerability and Efficacy of Asciminib (Oral) Versus Nilotinib (Oral) in Adult Participants (≥18 Years of Age) With Newly Diagnosed Philadelphia Chromosome Positive Chronic Myelogenous Leukemia in Chronic Phase (Ph+ CML-CP)Active
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Side effects by symptom · Immune-related side effects · Toxicity compare · Survivorship planner.
Access to any tyrosine kinase inhibitor, and to PCR monitoring, in low-income countries.
and how the field plans to fix it →What is being done about thisCost and accessAvailable now- Allogeneic stem cell transplantationStandard of care
- ImatinibApproved
- NilotinibApproved
In trialsNothing recorded yet.
Ideas and roadmapsNothing recorded yet.
Also on OnCo: Financial help · Coverage by country · HTA decisions.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Miami, FL · cancer center | United States | 0 | 1,607 | 15,145 | - | ||
Madrid · hospital | Spain | none recorded | 0 | 764 | 13,767 | - | |
Philadelphia, PA · cancer center | United States | 0 | 755 | 12,225 | - | ||
Pamplona · cancer center | Spain | none recorded | 0 | 751 | 10,993 | - | |
Seoul · hospital | South Korea | none recorded | 0 | 448 | 2,611 | - | |
| Spain | none recorded | 0 | 377 | 3,050 | - | ||
Toulouse · cancer center | France | none recorded | 0 | 232 | 3,172 | - | |
Indianapolis, IN · cancer center | United States | 0 | 159 | 4,238 | - | ||
Hamilton, ON · cancer center | Canada | none recorded | 0 | 103 | 1,158 | - | |
Baltimore, MD · cancer center | United States | 0 | 101 | 2,306 | - | ||
Sydney · hospital | Australia | none recorded | 0 | 98 | 893 | - | |
Portland, OR · cancer center | United States | 0 | 62 | 620 | - | ||
Chicago, IL · cancer center | United States | 0 | 43 | 2,105 | - | ||
Omaha, NE · cancer center | United States | 0 | 37 | 4,159 | - | ||
Rotterdam · consortium | Netherlands | none recorded | 0 | 8 | 207 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Chronic myeloid leukaemia, chronic phase but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Chronic myeloid leukaemia, chronic phase
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example BCR::ABL1 transcript by quantitative PCR on the International Scale, ELTS and Sokal risk scores, Karyotype and additional chromosomal abnormalities, BCR::ABL1 kinase domain mutations, Depth of molecular responsefor stopping), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Newly diagnosed chronic phase, low ELTS risk, Newly diagnosed chronic phase, high ELTS risk, Chronic phase resistant or intolerant to first tyrosine kinase inhibitor.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Newly diagnosed chronic phase
- For my situation (newly diagnosed chronic phase), which of the standard options do you recommend and why?Why: Guideline options include: Imatinib 400 mg daily, a second-generation inhibitor (dasatinib, nilotinib, bosutinib) chosen by comorbidity and treatment goal, or asciminib (ASC4FIRST); PCR at 3, 6 and 12 months against ELN milestones.
- Am I a candidate for Imatinib, Dasatinib, Nilotinib or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of Oral Asciminib Versus Other TKIs in Adult Patients With Newly Diagnosed Ph+ CML-CP and A Study to Investigate Tolerability and Efficacy of Asciminib (Oral) Versus Nilotinib (Oral) in Adult Participants (≥18 Years of Age) With Newly Diagnosed Philadelphia Chromosome Positive Chronic Myelogenous Leukemia in Chronic Phase (Ph+ CML-CP) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Resistance or intolerance
- For my situation (resistance or intolerance), which of the standard options do you recommend and why?Why: Guideline options include: Switch inhibitor guided by kinase domain mutation testing; ponatinib or asciminib for T315I; radotinib or olverembatinib where approved; allogeneic transplant after failure of two or more inhibitors.
- Am I a candidate for Ponatinib, Asciminib, Olverembatinib or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of Study of Olverembatinib (HQP1351) in Patients With CML-CP and A Phase 3 Study for the Efficacy and Safety of Radotinib in CP-CML Patients With Failure or Intolerance to Previous TKIs apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Sustained deep molecular response
- For my situation (sustained deep molecular response), which of the standard options do you recommend and why?Why: Guideline options include: Attempt treatment-free remission after at least three to five years of therapy and two years of MR4 or better, with monthly PCR for six months; restart on loss of major molecular response.
Any stage
- Are there clinical trials I could join, for example of Asciminib, Olverembatinib, Radotinib, A Study of Oral Asciminib Versus Other TKIs in Adult Patients With Newly Diagnosed Ph+ CML-CP?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “The leukaemic stem cells that survive kinase inhibition and cause relapse after stopping”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Cardiovascular toxicity over decades on second- and third-generation inhibitors”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Chronic myeloid leukaemia, chronic phase, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
4targets
3drugs
8companies
5pathways
2terms
4trials
6key papers
2IRIS made imatinib the first-line standard for CML worldwide and established the tyrosine kinase inhibitor as a chronic, life-long oral therapy. For most patients CML became a manageable condition with near-normal life expectancy. Later generations of TKIs (dasatinib, nilotinib, asciminib) produce faster, deeper responses but have not shown a survival advantage over imatinib.
Druker's 2001 imatinib paper turned the idea of hitting a cancer's specific molecular engine into a working medicine. For people with CML it began the shift from a fatal disease treated with interferon or transplant to one managed with a daily tablet. It also set expectations, later tempered, that every cancer might have its own imatinib.
Latest papers
topQuery for this cancer: (TITLE:"Chronic myeloid leukaemia, chronic phase" OR ABSTRACT:"Chronic myeloid leukaemia, chronic phase" OR TITLE:"CML-CP" OR ABSTRACT:"CML-CP" OR TITLE:"Chronic-phase CML" OR ABSTRACT:"Chronic-phase CML" OR TITLE:"Newly diagnosed Ph-positive CML" OR ABSTRACT:"Newly diagnosed Ph-positive CML" OR TITLE:"BCR::ABL1-positive chronic phase" OR ABSTRACT:"BCR::ABL1-positive chronic phase") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Chronic myeloid leukaemia, chronic phase, not a curated reading list.
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