Treatment response and survival outcomes with BCR-ABL tyrosine kinase inhibitors in chronic myeloid leukemia: a retrospective study

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Background Chronic myeloid leukemia (CML) is a highly controllable cancer after the introduction of BCR-ABL tyrosine kinase inhibitors (TKIs). However, in real-world settings, there is limited evidence on treatment response, resistance, and survival. Objective To measure treatment response, overall survival, and predictors of molecular response in patients with CML treated with BCR-ABL TKIs in routine clinical practice. Methodology This was a retrospective cohort study consisting of 650 adult patients with confirmed CML who received at least one BCR-ABL TKI between January 2023 and December 2025. All demographic, clinical, treatment, and follow-up data were abstracted from the institution’s medical records. Assessment was performed for hematologic, cytogenetic, and molecular responses according to standard criteria. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan–Meier analysis, and predictors of response and survival were identified using multivariable regression models. Results The mean age was 49.8 ± 14.2 years, and 57.8% were male. The majority of patients were seen in the chronic phase (91.1%). Complete hematologic response, complete cytogenetic response, major molecular response (MMR) and deep molecular response (DMR) were observed in 93.4, 83.4, 76.3 and 48.9% of patients, respectively. The second-generation TKIs had a significantly higher MMR rate than imatinib (82.9% vs. 71.8%, p < 0.001). 17.4% of patients were treatment-resistant, and 14.9% were treatment-intolerant. Three-year OS and PFS were 95.8 and 93.4%. MMR was independently predicted by younger age, chronic-phase disease, lower ELTS risk and second-generation TKIs. Conclusion Excellent molecular responses and favourable survival outcomes were observed among real-world patients with CML treated with BCR-ABL tyrosine kinase inhibitors. Molecular response remained an important prognostic indicator, supporting continued molecular monitoring and risk-adapted treatment. However, the available follow-up was insufficient to evaluate late-onset toxicities and longer-term treatment outcomes fully; therefore, extended follow-up studies with detailed molecular and genetic characterisation are warranted.