Chronic Myeloid Leukemia: Historical Perspective, Pathophysiology, and Treatment Advances

Chronic myeloid leukemia (CML) was the first leukemia to be described and remains one of the most well-studied hematologic malignancies. Since its initial description in 1845, CML has evolved from a fatal hematologic disease into a manageable chronic condition.

This review traces the historical evolution of CML research, from its first clinical recognition in the mid-19th century to modern molecular diagnostics and targeted therapy. Key milestones include the discovery of the Philadelphia chromosome in 1960, identification of the BCR::ABL1 fusion gene in the 1980s, and the subsequent development of tyrosine kinase inhibitors (TKIs). The introduction of imatinib in the early 2000s revolutionized CML treatment, transforming a fatal disease into a chronic condition with near-normal life expectancy for most patients. Second- and third-generation TKIs have since been introduced to overcome drug resistance and target specific BCR::ABL1 mutations, such as T315I. Recently, research has focused on mechanisms of TKI resistance, novel signaling pathways, and strategies to achieve treatment-free remission (TFR). Emerging therapies such as vamotinib, KF1601, and combination regimens are being explored. Furthermore, new insights into non-kinase functions of BCR::ABL1 and the role of microRNAs in resistance open additional therapeutic avenues.

CML remains the most successful example of how understanding molecular pathogenesis can directly translate into targeted therapy. Strategic shifts toward multi-generational TKIs and combination regimens are essential to address the challenges posed by clonal evolution and TKI resistance. Modern clinical goals have shifted to sustained TFR, aiming to transform CML from a chronic to a curable condition.