Evolution of the European LeukemiaNet recommendations for chronic myeloid leukemia

INTRODUCTION: Chronic myeloid leukemia (CML) management has been revolutionized by tyrosine kinase inhibitors (TKIs), leading to near-normal life expectancy for most patients diagnosed in the chronic phase. The European LeukemiaNet (ELN) recommendations provide the internationally recognized framework for the diagnosis, monitoring, and treatment of CML. AREAS COVERED: This review provides a chronological overview of the evolution of ELN recommendations for CML across five updates (2006, 2009, 2013, 2020, and 2025). Relevant literature published up to January 2026 was identified through a search of PubMed/MEDLINE, using keywords including 'chronic myeloid leukemia,' 'CML,' 'European LeukemiaNet,' 'ELN recommendations,' 'tyrosine kinase inhibitors,' and 'treatment-free remission.' EXPERT OPINION: Over time, ELN recommendations have shifted from cytogenetic to molecular monitoring, incorporated second-generation TKIs, and introduced treatment-free remission as a major therapeutic goal. The latest framework emphasizes personalized CML management by integrating molecular response with patient-specific factors, reflecting the broader evolution of precision medicine in hematology.