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General
- Cortes et al. Chronic myeloid leukaemia. Lancet 2021;398:1914
- Quintás-Cardama and Cortes. Molecular biology of bcr-abl1–positive chronic myeloid leukemia. Blood 2009;113:1619
- Schemionek et al. BCR-ABL enhances differentiation of long-term repopulating hematopoietic stem cells. Blood 2010; 115:3185
- Kim et al. Spectrum of somatic mutation dynamics in chronic myeloid leukemia following tyrosine kinase inhibitor therapy. Blood 2017;129:38(With editorial)
- Verma et al. Chronic myeloid leukemia (CML) with P190BCR-ABL: analysis of characteristics, outcomes, and prognostic significance. Blood 2009;114:2232
- Holyoake and Vetrie. The chronic myeloid leukemia stem cell: stemming the tide of persistence. Blood 2017;129:1595
- Radivoyevitch et al. Quantitative modeling of chronic myeloid leukemia: insights from radiobiology. Blood 2012;119:4363
- Hochhaus A. Managing chronic myeloid leukemia as a chronic disease. Hematology 2011:128
- Melo and Ross. Minimal Residual Disease and Discontinuation of Therapy in Chronic Myeloid Leukemia: Can We Aim at a Cure? Hematology 2011:136
- Shanmuganathan and Hughes. Molecular monitoring in CML: how deep? How often? How should it influence therapy? Blood 2018;132:2125
- Radich et al. New approaches to molecular monitoring in CML (and other diseases). Blood 2019;134:1578
- Kantarjian et al. Significance of Increasing Levels of Minimal Residual Disease in Patients With Philadelphia Chromosome–Positive Chronic Myelogenous Leukemia in Complete Cytogenetic Response. J Clin Oncol 2009;27:3659
- Kreutzman et al. Mono/oligoclonal T and NK cells are common in chronic myeloid leukemia patients at diagnosis and expand during dasatinib therapy. Blood 2010;116:772
- Fabarius et al. Impact of additional cytogenetic aberrations at diagnosis on prognosis of CML: long-term observation of 1151 patients from the randomized CML Study IV. Blood 2011;118:6760(Add’nl Ph chromosome, trisomy 8, isochromosome 17q and trisomy 19 associated with worse prognosis and progression to blast crisis)
- Wang et al. Risk stratification of chromosomal abnormalities in chronic myelogenous leukemia in the era of tyrosine kinase inhibitor therapy. Blood 2016;127:2742
- Saußele et al. Impact of comorbidities on overall survival in patients with chronic myeloid leukemia: results of the randomized CML Study IV. Blood 2015;126:42
- Prost et al. Erosion of the chronic myeloid leukaemia stem cell pool by PPARγ agonists. Nature 2015;525:380(Pioglitazone treatment resulted in sustained molecular remission in 3 patients with residual disease despite nilotinib treatment. See also NEJM summaryof this research)
- Kuntz et al. Targeting mitochondrial oxidative phosphorylation eradicates therapy-resistant chronic myeloid leukemia stem cells. Nat Med 2017;23:1234
- Giustacchini et al. Single-cell transcriptomics uncovers distinct molecular signatures of stem cells in chronic myeloid leukemia. Nat Med 2017;23:692(Identifies a population of leukemic stem cells that may give rise to therapy-resistant relapse; with editorial)
- Kesarwani et al. Targeting c-FOS and DUSP1 abrogates intrinsic resistance to tyrosine-kinase inhibitor therapy in BCR-ABL-induced leukemia. Nat Med 2017;23:472
- Zhang et al. Bone marrow niche trafficking of miR-126 controls the self-renewal of leukemia stem cells in chronic myelogenous leukemia. Nat Med 2018;24:450
Tyrosine kinase inhibitors in CML – general
- Guilhot and Hellmann. Long-term outcomes of tyrosine kinase inhibitors in chronic myeloid leukemia. Blood 2025;145:910
- Berman E. How I treat chronic-phase chronic myelogenous leukemia. Blood 2022;139:3138
- Hughes and Ross. Moving treatment-free remission into mainstream clinical practice in CML. Blood 2016;128:17(About half of patients with stable deep molecular response can maintain remission off TKI therapy)
- Larson RA. Is there a best TKI for chronic phase CML? Blood 2015;126:2370
- Cortes J. How to manage CML patients with comorbidities. Blood 2020;136:2507
- Smith and Shah. Tyrosine Kinase Inhibitor Therapy for Chronic Myeloid Leukemia: Approach to Patients with Treatment-Naive or Refractory Chronic-Phase Disease. Hematology 2011:121
- Soverini et al. Prospective assessment of NGS-detectable mutations in CML patients with nonoptimal response: the NEXT-in-CML study. Blood 2020;135:534(Improved dectection of low-level TKI mutations that can cause treatment failure)
- Jabbour et al. The achievement of an early complete cytogenetic response is a major determinant for outcome in patients with early chronic phase chronic myeloid leukemia treated with tyrosine kinase inhibitors. Blood 2011;118:4541
- Branford et al. Early molecular response and female sex strongly predict stable undetectable BCR-ABL1, the criteria for imatinib discontinuation in patients with CML. Blood 2013;121:3818
- Jain et al. Early responses predict better outcomes in patients with newly diagnosed chronic myeloid leukemia: results with four tyrosine kinase inhibitor modalities. Blood 2013;121:4867
- Branford et al. Prognosis for patients with CML and >10% BCR-ABL1 after 3 months of imatinib depends on the rate of BCR-ABL1 decline. Blood 2014;124:511
- Sobrinho-Simões et al. In search of the original leukemic clone in chronic myeloid leukemia patients in complete molecular remission after stem cell transplantation or imatinib. Blood 2010;116:1329(Absence of detectable BCR-ABL transcripts does not imply the absence of the leukemic clone)
- Iacobucci et al. Comparison Between Patients With Philadelphia-Positive Chronic Phase Chronic Myeloid Leukemia Who Obtained a Complete Cytogenetic Response Within 1 Year of Imatinib Therapy and Those Who Achieved Such a Response After 12 Months of Treatment. J Clin Oncol 2006;24:454(DFS at 4 years similar in early and late responders)
- Ibrahim et al. Poor adherence is the main reason for loss of CCyR and imatinib failure for chronic myeloid leukemia patients on long-term therapy. Blood 2011;117:3733
- Russo et al. Effects and outcome of a policy of intermittent imatinib treatment in elderly patients with chronic myeloid leukemia. Blood 2013;121:5138(Some patients had molecular or cytogenetic progress, none had blast crisis or new cytogenetic abnormality; all responded to imatinib when re-treated)
- Branford et al. Selecting optimal second-line tyrosine kinase inhibitor therapy for chronic myeloid leukemia patients after imatinib failure: does the BCR-ABL mutation status really matter? Blood 2009;114:5426
- Kantarjian et al. New Insights into the Pathophysiology of Chronic Myeloid Leukemia and Imatinib Resistance. Ann Intern Med 2006;145:913
- O’Hare et al.Bcr-Abl kinase domain mutations, drug resistance, and the road to a cure for chronic myeloid leukemia. Blood 2007;110:2242
- Soverini et al. BCR-ABL kinase domain mutation analysis in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: recommendations from an expert panel on behalf of European LeukemiaNet. Blood 2011;118:1208
- Parker et al. Poor response to second-line kinase inhibitors in chronic myeloid leukemia patients with multiple low-level mutations, irrespective of their resistance profile. Blood 2012;199:2234
- Jain et al. Impact of BCR-ABL transcript type on outcome in patients with chronic-phase CML treated with tyrosine kinase inhibitors. Blood 2016;127:1269
- Jabbour et al. Predictive factors for outcome and response in patients treated with second-generation tyrosine kinase inhibitors for chronic myeloid leukemia in chronic phase after imatinib failure. Blood 2011;117:1822(Poor performance status, no cytogenetic response to imatinib associated with low response rate)
- Milojkovic et al. Responses to second-line tyrosine kinase inhibitors are durable: an intention-to-treat analysis in chronic myeloid leukemia patients. Blood 2012;119:1838
- Tam et al. Failure to achieve a major cytogenetic response by 12 months defines inadequate response in patients receiving nilotinib or dasatinib as second or subsequent line therapy for chronic myeloid leukemia. Blood 2008;112:516
- Garg et al. The use of nilotinib or dasatinib after failure to 2 prior tyrosine kinase inhibitors: long-term follow-up. Blood 2009;114:4361(Third-line TKI therapy typically does not give durable response)
- Dahlén et al. Cardiovascular Events Associated With Use of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Population-Based Cohort Study. Ann Intern Med 2016;165:161(1.5-fold higher risk of arterial events, 2-fold higher VTE risk in TKI-treated patients)
- Moslehi et al. Tyrosine Kinase Inhibitor–Associated Cardiovascular Toxicity in Chronic Myeloid Leukemia. J Clin Oncol 2015;33:4210
- Quintás-Cardama et al. Tyrosine kinase inhibitor–induced platelet dysfunction in patients with chronic myeloid leukemia. Blood 2009; 114:261(Dasatinib treatment causes impaired platelet aggregation)
- Haouala et al. Drug interactions with the tyrosine kinase inhibitors imatinib, dasatinib, and nilotinib. Blood 2011;117:e75
- Verma et al. Malignancies occurring during therapy with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) and other hematologic malignancies. Blood 2011;118:4353(No evidence that TKIs increase risk of 2nd malignancies)
- Efficace et al. Health-related quality of life in chronic myeloid leukemia patients receiving long-term therapy with imatinib compared with the general population. Blood 2011;118:4554(Fatigue most common problem, especially in younger patients)
- Hughes et al. The evolution of treatment-free remission. Blood 2025;145:921
- Rousselot et al. Loss of Major Molecular Response As a Trigger for Restarting Tyrosine Kinase Inhibitor Therapy in Patients With Chronic-Phase Chronic Myelogenous Leukemia Who Have Stopped Imatinib After Durable Undetectable Disease. J Clin Oncol 2014;32:424
- Rea et al. Discontinuation of dasatinib or nilotinib in chronic myeloid leukemia: interim analysis of the STOP 2G-TKI study. Blood 2017;129:846(43% had molecular relapse at median of 4 mo, all patients responded to retreatment)
- Clark et al. De-escalation of tyrosine kinase inhibitor dose in patients with chronic myeloid leukaemia with stable major molecular response (DESTINY): an interim analysis of a non-randomised, phase 2 trial. Lancet Haematol 2017;4:e310(Cutting TKI dose in half safe for most patients in MMR)
- Etienne et al. Long-Term Follow-Up of the French Stop Imatinib (STIM1) Study in Patients With Chronic Myeloid Leukemia. J Clin Oncol 2017;35:298(38% remained in molecular remission at 5 yrs; almost all patients who progressed responded to restarting treatment)
- Kimura et al. Treatment-free remission after first-line dasatinib discontinuation in patients with chronic myeloid leukaemia (first-line DADI trial): a single-arm, multicentre, phase 2 trial. Lancet Haematol 2020;7:e218(55% of patients with deep molecular response after 3 years of treatment remained in remission 6 mo after stopping therapy)
- Hughes et al. Asciminib in Chronic Myeloid Leukemia after ABL Kinase Inhibitor Failure. NEJM 2019;381:2315
- Yeung et al. Asciminib: a new therapeutic option in chronic-phase CML with treatment failure. Blood 2022;139:3474
- Hochhaus et al. Asciminib in Newly Diagnosed Chronic Myeloid Leukemia. NEJM 2024 ;391:885
- Berman et al. Chronic Myelogenous Leukemia: Pregnancy in the Era of Stopping Tyrosine Kinase Inhibitor Therapy. J Clin Oncol 2018;36:1250
Imatinib
- Druker et al. Efficacy and safety of a specific inhibitor of the bcr-abl tyrosine kinase in chronic myeloid leukemia. NEJM 2001;344:1031
- Druker et al. Activity of a specific inhibitor of the bcr-abl tyrosine kinase in the blast crisis of chronic myeloid leukemia and acute lymphoblastic leukemia with the Philadelphia chromosome. NEJM 2001;344:1038
- Picard et al. Trough imatinib plasma levels are associated with both cytogenetic and molecular responses to standard-dose imatinib in chronic myeloid leukemia. Blood 2007;109:3469
- Larson et al. Imatinib pharmacokinetics and its correlation with response and safety in chronic-phase chronic myeloid leukemia: a subanalysis of the IRIS study. Blood 2008;111:4022(Adequate plasma concentration predicts better clinical response)
- Kantarjian et al. Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. NEJM 2002;346:645
- Gugliotta et al. Frontline imatinib treatment of chronic myeloid leukemia: no impact of age on outcome, a survey by the GIMEMA CML Working Party. Blood 2011;117:5591
- Hehlmann et al. Deep Molecular Response Is Reached by the Majority of Patients Treated With Imatinib, Predicts Survival, and Is Achieved More Quickly by Optimized High-Dose Imatinib: Results From the Randomized CML-Study IV. J Clin Oncol 2014;32:416(>4.5 log reduction of BCR-ABL)
- Kantarjian et al. High-dose imatinib mesylate therapy in newly diagnosed Philadelphia chromosome–positive chronic phase chronic myeloid leukemia. Blood 2004;103:2873
- Hughes et al. Impact of early dose intensity on cytogenetic and molecular responses in chronic- phase CML patients receiving 600 mg/day of imatinib as initial therapy. Blood 2008;112:3965(escalation to 800 mg in patients with suboptimal response at 6 mo appeared beneficial)
- Baccarani et al. Comparison of imatinib 400 mg and 800 mg daily in the front-line treatment of high-risk, Philadelphia-positive chronic myeloid leukemia: a European LeukemiaNet Study. Blood 2009;113:4497(No significant difference in response rate)
- Preudhomme et al. Imatinib plus Peginterferon Alfa-2a in Chronic Myeloid Leukemia. NEJM 2010;363:2511(Addition of peginterferon doubled rate of molecular response at 12 months, but caused more toxicity)
- Simonsson et al. Combination of pegylated IFN-α2b with imatinib increases molecular response rates in patients with low- or intermediate-risk chronic myeloid leukemia. Blood 2011;118:3228
- Druker et al. Five-Year Follow-up of Patients Receiving Imatinib for Chronic Myeloid Leukemia. NEJM 2006;355:2408(89% 5-year overall survival, 83% event-free survival)
- Hochhaus et al. Favorable long-term follow-up results over 6 years for response, survival, and safety with imatinib mesylate therapy in chronic-phase chronic myeloid leukemia after failure of interferon- treatment. Blood 2008;111:1039
- Hochhaus et al. Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid Leukemia. NEJM 2017;376:917(Efficacy maintained over 11 year followup without major toxicity; with editorial)
- Rousselot et al. Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years. Blood 2007;109:58 (6 of 12 patients remained in molecular remission during median followup of 18 mo)
- Ross et al. Safety and efficacy of imatinib cessation for CML patients with stable undetectable minimal residual disease: results from the TWISTER study. Blood 2013;122:515(About half remained in molecular remission after 2 yr; the rest were all successfully re-treated)
- Hughes et al. Long-term prognostic significance of early molecular response to imatinib in newly diagnosed chronic myeloid leukemia: an analysis from the International Randomized Study of Interferon and STI571 (IRIS). Blood 2010;116:3758(Patients with major molecular response had durable responses/remissions)
- Atallah et al. Congestive heart failure is a rare event in patients receiving imatinib therapy. Blood 2007; 110:1233(1.7% incidence, only 0.6% considered due to drug)
- Fitter et al. Long-term imatinib therapy promotes bone formation in CML patients. Blood 2008;111:2538
- Vandyke et al. Dysregulation of bone remodeling by imatinib mesylate. Blood 2010;115:766
- Pye et al. The effects of imatinib on pregnancy outcome. Blood 2008;111:5505
- Mauro MJ. Defining and Managing Imatinib Resistance. Hematology 2006;226-39
- Jabbour et al. Imatinib mesylate dose escalation is associated with durable responses in patients with chronic myeloid leukemia after cytogenetic failure on standard-dose imatinib therapy. Blood 2009;113:2154
- Yeung et al. TIDEL-II: first-line use of imatinib in CML with early switch to nilotinib for failure to achieve time-dependent molecular targets. Blood 2015;125:915(This strategy considered to produce excellent results, more cost-effective than routine use of newer agents)
Dasatinib
- Kantarjian et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. NEJM 2010;362:2260(Dasatinib superior)
- Kantarjian et al. Dasatinib or imatinib in newly diagnosed chronic-phase chronic myeloid leukemia: 2-year follow-up from a randomized phase 3 trial (DASISION)(Dasatinib shows “faster and deeper” responses; transformation to accelerated or blast phase occurred in 2.3% vs 5% with imatinib)
- Jabbour et al. Early response with dasatinib or imatinib in chronic myeloid leukemia: 3-year follow-up from a randomized phase 3 trial (DASISION). Blood 2014;123:494
- Radich et al. A randomized trial of dasatinib 100 mg versus imatinib 400 mg in newly diagnosed chronic-phase chronic myeloid leukemia. Blood 2012;120:3898(Dasatanib produced more complete cytogenetic responses, better molecular responses, more toxicity; similar survival in both arms at medial 3 year followup)
- Talpaz et al. Dasatinib in Imatinib-Resistant Philadelphia Chromosome�Positive Leukemias. NEJM 2006;354:2531
- Hochhaus et al. Dasatinib induces notable hematologic and cytogenetic responses in chronic-phase chronic myeloid leukemia after failure of imatinib therapy. Blood 2007;109:2303
- Guilhot et al. Dasatinib induces significant hematologic and cytogenetic responses in patients with imatinib-resistant or -intolerant chronic myeloid leukemia in accelerated phase. Blood 2007;109:4143
- Cortes et al. Dasatinib induces complete hematologic and cytogenetic responses in patients with imatinib-resistant or -intolerant chronic myeloid leukemia in blast crisis. Blood 2007;109:3207(about a third of patients had good response to dasatinib)
- Kantarjian et al. Dasatinib or high-dose imatinib for chronic-phase chronic myeloid leukemia after failure of first-line imatinib: a randomized phase 2 trial. Blood 2007;109:5143(Dasatinib superior)
- Cortes et al. Final 5-Year Study Results of DASISION: The Dasatinib Versus Imatinib Study in Treatment-Naïve Chronic Myeloid Leukemia Patients Trial. J Clin Oncol 2016;34:2333(Modest improvement in outcomes with dasatinib)
- Müller et al. Dasatinib treatment of chronic-phase chronic myeloid leukemia: analysis of responses according to preexisting BCR-ABL mutations. Blood 2009; 114:4944
- Shah et al. Long-term outcome with dasatinib after imatinib failure in chronic-phase chronic myeloid leukemia: follow-up of a phase 3 study. Blood 2014;123:2317(Long term outcomes good if <10% BCR-ABL transcripts within 3 mo)
- Montani et al. Pulmonary arterial hypertension in patients treated by dasatinib. Circulation 2012;125:2128
Nilotinib
- Saglio et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. NEJM 2010;362:2251 (Nilotinib superior)
- Cortes et al. Nilotinib as front-line treatment for patients with chronic myeloid leukemia in early chronic phase. J Clin Oncol 2010;28:392
- Kantarjian et al. Nilotinib in Imatinib-Resistant CML and Philadelphia Chromosome�Positive ALL. NEJM 2006;354:2542
- Katarjian et al. Nilotinib is effective in patients with chronic myeloid leukemia in chronic phase after imatinib resistance or intolerance: 24-month follow-up results. Blood 2011;117:1141
- Kantarjian et al. Nilotinib (formerly AMN107), a highly selective BCR-ABL tyrosine kinase inhibitor, is effective in patients with Philadelphia chromosome–positive chronic myelogenous leukemia in chronic phase following imatinib resistance and intolerance. Blood 2007;110:3540
- le Coutre et al. Nilotinib (formerly AMN107), a highly selective BCR-ABL tyrosine kinase inhibitor, is active in patients with imatinib-resistant or -intolerant accelerated-phase chronic myelogenous leukemia. Blood 2008;111:1834
- Cortes et al. Minimal cross-intolerance with nilotinib in patients with chronic myeloid leukemia in chronic or accelerated phase who are intolerant to imatinib. Blood 2011;117:5600
- Rosti et al. Nilotinib for the frontline treatment of Ph+ chronic myeloid leukemia. Blood 2009;114:4933
- Wang et al. Phase 3 study of nilotinib vs imatinib in Chinese patients with newly diagnosed chronic myeloid leukemia in chronic phase: ENESTchina. Blood 2015;125:2771(MMR in 28% getting imatinib, 52% getting nilotinib after 1 yr)
- Mahon et al. Treatment-Free Remission After Second-Line Nilotinib Treatment in Patients With Chronic Myeloid Leukemia in Chronic Phase: Results From a Single-Group, Phase 2, Open-Label Study. Ann Intern Med 2018;168:461(Over 50% of patients maintained molecular remission after 96 weeks off treatment)
Other TKIs
- Cortes et al. Safety and efficacy of bosutinib (SKI-606) in chronic phase Philadelphia chromosome–positive chronic myeloid leukemia patients with resistance or intolerance to imatinib. Blood 2011;118:4567
- Khoury et al. Bosutinib is active in chronic phase chronic myeloid leukemia after imatinib and dasatinib and/or nilotinib therapy failure. Blood 2012;119:3403
- Cortes et al. Bosutinib Versus Imatinib in Newly Diagnosed Chronic-Phase Chronic Myeloid Leukemia: Results From the BELA Trial. J Clin Oncol 2012;30:3486
- Kantarjian et al. Bosutinib safety and management of toxicity in leukemia patients with resistance or intolerance to imatinib and other tyrosine kinase inhibitors. Blood 2014;123:1309
- Cortes et al. Bosutinib Versus Imatinib for Newly Diagnosed Chronic Myeloid Leukemia: Results From the Randomized BFORE Trial. J Clin Oncol 2018;36:231(12-mo MMR rate 47% with bosutinib, 37% with imatinib)
- Cortes et al. Ponatinib in refractory Philadelphia chromosome-positive leukemias. NEJM 2012;367:2075
- Parker et al. The impact of multiple low-level BCR-ABL1 mutations on response to ponatinib. Blood 2016;127:1870(Ponatinib effective in TKI-resistant disease with multiple mutations in BCR-ABL)
- Cortes et al. A phase 2 trial of ponatinib in Philadelphia chromosome-positive leukemias. NEJM 2013;369:1783 (Ponatinib effective; 9% incidence of serious thrombotic events)
- Cortes et al. Ponatinib efficacy and safety in Philadelphia chromosome–positive leukemia: final 5-year results of the phase 2 PACE trial. Blood 2018;132:393
- Cortes et al. Ponatinib dose-ranging study in chronic-phase chronic myeloid leukemia: a randomized, open-label phase 2 clinical trial. Blood 2021;138:2042
- Yeung et al. Asciminib monotherapy as frontline treatment of chronic-phase chronic myeloid leukemia: results from the ASCEND study. Blood 2024;144:1993 (Very effective and well-tolerated)
- Latifi et al. Thrombotic microangiopathy as a cause of cardiovascular toxicity from the BCR-ABL1 tyrosine kinase inhibitor ponatinib. Blood 2019;133:1597
Accelerated phase & blast crisis
- Radich J. The biology of CML blast crisis. Hematology 2007:384
- Hehlman R. How I treat CML in blast crisis. Blood 2012;120:737
- Wadhwa et al. Factors affecting duration of survival after onset of blastic transformation of chronic myeloid leukemia. Blood 2002;99:2304
- Apperley et al. Dasatinib in the Treatment of Chronic Myeloid Leukemia in Accelerated Phase After Imatinib Failure: The START A Trial. J Clin Oncol 2009; 27:3472
- Jiang et al. Imatinib mesylate versus allogeneic hematopoietic stem cell transplantation for patients with chronic myelogenous leukemia in the accelerated phase. Blood 2011;117:3032(SCT superior in patients with CML > 1yr, Hgb < 10, or periph blasts > 5%)