Chronic myeloid leukemia from pathophysiology to treatment-free remission: new perspectives

Chronic myeloid leukemia (CML) is one of the most common leukaemia’s occurring in the adult population. The course of CML is divided into three phases: the chronic phase, the acceleration phase and the blast phase. CML is a chronic myeloproliferative neoplasm characterized by the presence of the chimeric BCR-ABL1 gene, resulting from the chromosomal translocation t (9;22) (q34;q11), which encodes a constitutively active tyrosine kinase. The advent of tyrosine kinase inhibitors (TKIs) has revolutionized the management of CML, significantly improving patient survival and quality of life. Recent studies have shown that a subgroup of patients can maintain deep remission even after treatment discontinuation, a phenomenon known as treatment-free remission (TFR) . This narrative review synthesizes the current evidence on the pathophysiology of CML, therapeutic advances with TKIs and the clinical and prognostic criteria associated with TFR, providing an integrated view that can guide clinical practice and future research.