A treatment algorithm

• A young patient (<40) with CML in chronic phase with a matched sibling 167 donor should probably still be allografted within 6-12 months of diagnosis but may prefer a trial of imatinib.

• All other patients should receive imatinib (in the UK if fail to tolerate IFN-a); review BM cytogenetics at 6 months.

• If BM <35% Ph-negative, alternatives should be discussed: i.e. increased Imatinib, trials of combination therapy or stem cell transplantation, if an option.

• If BM >35% Ph-neg continue therapy as long as cytogenetics stable or improving (RT-PCR for BCR-ABL if CCR).

• Monitor at least annually; if progression, discuss above options especially BMT.

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