[Treatment strategies for chronic-phase chronic myeloid leukemia in 2026]

The prognosis of chronic-phase chronic myeloid leukemia (CP-CML) has improved substantially since the introduction of tyrosine kinase inhibitor (TKI) therapy. Accordingly, treatment strategies now extend beyond disease control to include improving quality of life and achieving treatment-free remission (TFR). This review discusses first-line treatment selection based on the EUTOS long-term survival (ELTS) score, patient age, and the risk of vascular adverse events; the efficacy and safety profiles of second-generation TKIs, ponatinib, and asciminib; molecular response milestones according to treatment goals; and current approaches to TKI dose optimization. Furthermore, it summarizes treatment selection in the second-line and later settings based on BCR::ABL1 mutation analysis in patients with resistant disease, as well as the results of TFR clinical trials conducted in Japan. Drawing on this evidence, this review presents practical treatment strategies for CP-CML tailored to patient characteristics and therapeutic goals.