2025 European LeukemiaNet recommendations for the management of chronic myeloid leukemia
- Study type
- Clinical guideline
- Study name
- ELN 2025 (CML)
- Design
- Recommendations of the ELN international expert panel (fifth edition) based on evidence published since 2020
- Source
- Leukemia · 2025
In plain words
This is the latest European guideline for treating CML. The oral drugs imatinib, dasatinib, nilotinib, bosutinib and asciminib are all options for first treatment, and the choice is made according to each patient's situation. Stopping the drug after several years of deep and lasting response, under close monitoring, is successful in about 40 to 50% of patients.
Key guideline recommendations
First-line drugs are imatinib (400 mg daily), dasatinib (100 mg daily), nilotinib (300 mg twice daily), bosutinib (400 mg daily) and asciminib (80 mg daily), and the choice is based on the treatment goal, ELTS risk score, comorbidities and age.
A decision to change treatment should not be based on a single BCR::ABL1 measurement.
Minimum conditions for TKI discontinuation: first chronic phase, treatment for more than 5 years (more than 4 years with a second-generation TKI) and deep molecular response (MR4 or better) for more than 2 years, together with access to standardised molecular monitoring and acceptance of frequent monitoring after stopping.
Men taking a TKI should continue treatment when trying to conceive with their partner; dasatinib should be avoided throughout pregnancy.
Study population
Adults with chronic myeloid leukaemia (CML); covering first-line and subsequent treatment, molecular monitoring, treatment discontinuation, pregnancy and transplantation.
Clinical significance and place in guidelines
Replaces the ELN 2020 recommendations: the response terms have changed to "optimal, warning and failure", the decision to switch TKI has become more individualised, dose reduction is preferred for managing adverse effects, and the recommendations on pregnancy and treatment discontinuation have been updated.
Limitations
Most recommendations rest on expert consensus; the panel could neither fully endorse nor reject the two-phase classification of the World Health Organization.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.