Chronic myeloid leukemia in Mexico: 2 decades of experience at the Hospital Central Militar

• Median age at CML diagnosis in Mexico is 43 years, almost two decades earlier than in high-income countries. • In a military system with universal TKI access, 10-year OS reached 90%. Chronic myeloid leukemia (CML) is the most frequent chronic leukemia in Mexico, with patients diagnosed nearly two decades younger than in high-income countries. While tyrosine kinase inhibitors (TKIs) have transformed outcomes, disparities in access persist in civilian hospitals. The military health system, in contrast, guarantees universal TKI access. We conducted a retrospective cohort study of patients with CML treated at the Hospital Central Militar (HCM) between January 2000 and July 2024. Clinical characteristics, treatment patterns, and survival outcomes were analyzed. Kaplan–Meier estimates were used for overall survival (OS). Sixty-six patients were included. The median age at diagnosis was 43.3 years (IQR, 36.3–52.1); 33.3% (n=22) were <40 years and 10.6% (n=7) were ≥60 years. First-line treatment consisted of imatinib in 92.4% (n=61), dasatinib in 3.0% (n=2), and nilotinib in 4.5% (n=3). Sixty-two percent of patients (n = 41) required second-line therapy, predominantly due to inadequate response. The median follow-up was 5 years (range, 0–24.5). Overall survival (OS) probabilities were 98.1% at 5 years, 90.3% at 10 years, and 72.4% at 15 years; the median OS was not reached. Outcomes were preserved even among patients requiring ≥2 lines. In this military cohort, where TKI access was universally guaranteed, survival was comparable to international benchmarks despite the younger age at diagnosis. These results indicate that favorable long-term survival can be observed in settings with uninterrupted access to therapy. The next step is to strengthen molecular monitoring and implement structured treatment-free remission programs to consolidate these gains.