The mainstay of therapy for chronic phase CML is TKI therapy. There are currently three TKIs approved and reimbursed for first-line therapy in Australia: imatinib, nilotinib and dasatinib. All three represent excellent choices, but the preferred TKI for each patient will depend on a combination of CML risk score (ELTS), comorbidity assessment (including Framingham risk score or equivalent) and the patient’s motivation to achieve treatment-free remission. Ideally, the choice of TKI should be a shared decision between the clinician and patient after an in-depth discussion of the advantages and disadvantages of each drug and to consider any available clinical trials that may be available.

It’s important not to rush this decision to give the patient time to consider the advantages and disadvantages of each option.

Ideally TKI therapy should start within the first four weeks, unless there is a specific indication to delay.