The treatment strategy for children and adolescents with chronic myeloid leukemia in the chronic phase (CML-CP) has evolved from allogeneic hematopoietic stem cell transplantation (HSCT) to tyrosine kinase inhibitors (TKIs). With the advent of next-generation TKIs and new targeted therapies in the CML field, an international pediatric CML expert panel provides recommendations based on the medical literature (including previous pediatric guidelines), national standards, and treatment principles used in adults with CML-CP. Recommendations include diagnosis of the disease and details on managing the initial steps of care of children and adolescents with newly diagnosed CML-CP, including complications such as leukostasis. The treatment recommendations are based on the initiation of therapy with a first- or second-generation TKI according to the allocated European Treatment and Outcome Study (EUTOS) long-term survival score risk group of the patient. The subsequent steps are based on the results of recommended monitoring which can justify a switch to another TKI or a drug in development if there is resistance or toxicity. The panel also provides recommendations regarding the discontinuation criteria for TKIs in children and adolescents in sustained deep molecular response. Allogeneic HSCT is not recommended as the first-line of treatment for children with CML-CP but is to be considered in case of progression to the advanced phase or failure of several lines of treatment. The present treatment and management recommendations are intended to provide advice to clinicians in view of optimizing the care and the outcome of children and adolescents with CML-CP.

2nd Department of Pediatrics School of Medicine Faculty of Health Sciences Aristotle University of Thessaloniki AHEPA University Hospital Thessaloniki Greece

Department of Paediatric Oncology Haematology Royal Marsden NHS Foundation Trust Sutton Sutton UK

Department of Pediatric Blood and Marrow Transplantation Princess Máxima Center Utrecht The Netherlands

Department of Pediatric Hemato Oncology Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands

Department of Pediatric Hematology and Oncology Medical Faculty Technical University Dresden Germany

Department of Pediatric Hematology Oncology Aghia Sophia Children's Hospital Athens Greece

Department of Pediatric Hematology Oncology and BMT Wroclaw Medical University Wroclaw Poland

Department of Pediatric Hematology Oncology and Stem Cell Transplantation Ghent University Hospital Ghent Belgium

Department of Pediatric Hematology Oncology University Hospital Motol Charles University Prague Czech Republic

Department of Pediatric Oncology Children's Cancer Hospital National Cancer Institute Cairo University Cairo Egypt

Department of Pediatric Oncology Tata Memorial Hospital Homi Bhabha National Institute Mumbai India

Department of Pediatrics and Adolescent Medicine St Anna Children's Hospital Medical University of Vienna Vienna Austria

Department of Pediatrics Keio University School of Medicine Tokyo Japan

Department of Pediatrics Lebanese American University Medical Center Rizk Hospital Beirut Lebanon

Division of Haematology Oncology Department of Pediatrics McMaster University Hamilton ON Canada

Division of Hematology Oncology BMT British Columbia Children's Hospital Research Institute Vancouver BC Canada

Division of Pediatric Hematology Oncology Stem Cell Transplant Department of Pediatrics Columbia University Irving Medical Center New York NY USA

Division of Pediatric Oncology and Hematology Department of Pediatrics and Adolescent Medicine University Hospital Erlangen Germany

Inserm CIC 1402 University Hospital of Poitiers Poitiers France

Labdia Labordiagnostik Vienna Austria

St Anna Children's Cancer Research Institute Vienna Austria

State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood Diseases Haihe Laboratory of Cell Ecosystem Institute of Hematology and Blood Diseases Hospital CAMS and PUMC Tianjin China

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