Goals of CML Treatment in the Tyrosine Kinase Inhibitor Era

The widespread introduction of tyrosine kinase inhibitor (TKI) therapy has radically changed the treatment strategy and goals of treatment of chronic myeloid leukemia (CML). In the past, allogeneic transplantation offered the only alternative for “curative” therapy, and the use of this modality was limited by patient age and donor availability. In a mere decade of use, TKI therapy has pushed transplantation to a salvage therapy, and most chronic-phase patients can expect prolonged response, with a small risk of progression to advanced-phase disease. Indeed, we now can speak of a “functional cure” and can now even consider discontinuing therapy for those patients without molecular evidence of disease. Given the multiple tyrosine kinase inhibitors now available to clinicians, as well as sensitive and relatively noninvasive methods to monitor disease response, we are now at the enviable phase of being able to optimize response based on the individual treatment goals of the patient and physician.