Authored by Natalia Gandur, published on 2026-10-05 17:19:00.0
Patient assessment
Assess: Age Comorbidities Functional status Life expectancy Cardiovascular and metabolic risk Pulmonary history Renal and hepatic function Concomitant medications and potential drug interactions Treatment access and adherence considerations Clarify the treatment goal, including long-term disease control and whether achieving a deep molecular response with the possibility of future treatment-free remission (TFR) is an important priority.
Limited reserve
Frailty and/or significant comorbidities. In patients with limited physiologic reserve, prioritize a frontline strategy that balances disease control with long-term tolerability and safety.
Lower-intensity strategy
Consider: Imatinib Reduced-dose second-generation TKI in selected patients Asciminib Individualize selection according to comorbidities, tolerability, drug-specific toxicity, access, and patient priorities.
Good functional status
Assess disease risk
Assess baseline disease risk using: ELTS — preferred Sokal score if used locally Risk scores help guide initial TKI intensity. Also consider the treatment goal: overall survival / durable disease control; rapid or deep molecular response; potential future treatment-free remission (TFR). High ELTS or intermediate-high Sokal risk favors consideration of a more potent upfront strategy.
Low-risk disease
Goal-directed choice Deep molecular response / TFR goal → second-generation TKI or asciminib Safety / cost priority → imatinib Individualize according to comorbidities, expected toxicity, access, and patient preference.
Potent upfront therapy
Consider: Second-generation TKI Asciminib A more potent frontline strategy may be favored in patients with higher-risk disease or when achieving a rapid/deep molecular response and potential future TFR is an important treatment goal. Select the specific agent according to comorbidities, toxicity profile, access, and patient preference.
Key principle
Overall survival is excellent with all frontline TKIs. Selection is driven by toxicity profile, response kinetics, comorbidities, treatment goals, and patient priorities.