Chronic myeloid leukaemia: A paradigm shift in management.

In early 2000, a better understanding of the molecular biology of chronic myeloid leukaemia established a central role for enhanced tyrosine kinase activity leading to targeted therapy with imatinib mesylate. This paradigm shift in the management of this disease has improved the median survival from 8-9 years before 2000 to an estimated 25 years. Rapid research in this area along with well-designed multicentric clinical trials have resulted in the development of second- and third-generation tyrosine kinase inhibitors, which are more effective for patients who develop resistance to imatinib. The synergy of haematological, cytogenetic and molecular parameters is the mainstay of monitoring patients with chronic myelod leukaemia. Early identification of patients likely to have suboptimal response to initial tyrosine kinase inhibitors and when to discontinue therapy in those with an optimal response are areas of active research.