In this 5th version of the European LeukemiaNet guidance for adult patients, there are important changes in several areas of management based on evidence available since 2020, including the World Health Organisation's reclassification of CML as a biphasic disease. Previous advice to switch the tyrosine kinase inhibitor (TKI) on failure of molecular milestones, is modified to better account for individual patient circumstances. Our recommendations are summarized in tables designed to be read in conjunction with the text which offers justification and additional advice. We describe decision-making for first-line treatment, both in available drugs and their initial dosing. Similarly we elaborate on dose reduction rather than drug switching to manage toxicities and discuss treatment sequencing. Data have matured for the outcome of treatment discontinuation and for management of parenting for both men and women. We acknowledge that most patients will remain on treatment for many years and emphasize the needs to minimize side effects, manage co-morbidities and optimize quality of life. Recent advances in allogeneic stem cell transplantation have broadened access to alternative donors, and lessened limitations of age and co-morbidities such that transplant remains a valuable option for patients for whom long-term disease control is not achieved through TKI therapy.

3 Med Clinic Medical Faculty Mannheim of the University of Heidelberg Mannheim Germany

Center for Cellular Immunotherapies University of Pennsylvania and Penn Medicine Philadelphia PA USA

Centre for Haematology Imperial College London Hammersmith Hospital London UK

Département d'Hématologie Hôpital Saint Louis APHP Paris France

Département d'Hématologie Institut Bergonié University of Bordeaux Inserm UMR1312 Bordeaux France

Department of Clinical and Biological Sciences University of Turin Turin Italy

Department of Haematology Hammersmith Hospital London UK

Department of Hematology Eulji Medical Center Eulji University Daejeon South Korea

Department of Hematology Karolinska University Hospital and Karolinska Institutet Stockholm Sweden

Department of Hematology Radboud University Medical Center Nijmegen The Netherlands

Department of Hematology St Olavs Hospital Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway

Department of Medical and Surgical Sciences Institute of Hematology Lorenzo e Ariosto Seràgnoli University of Bologna Bologna Italy

Department of Medical Oncology Sri Ram Cancer and Super Specialty Center Mahatma Gandhi Medical College Hospital Mahatma Gandhi University of Medical Sciences and Technology Jaipur India

Department of Medicine Division of Hematology Oncology University of Michigan Ann Arbor MI USA

Department of Molecular and Clinical Cancer Medicine University of Liverpool Liverpool UK

Department of Molecular Medicine and Gene Therapy Lund University Lund Sweden

Department of Oncology and Hematology University Federico 2 of Naples Naples Italy

Division of Hematology and Medical Oncology Cornell Medicine New York NY USA

Georgia Cancer Center at Augusta University Augusta GA USA

Hematology Department and INSERM U1052 CRCL Centre Léon Bérard Lyon Cédex 08 France

Hematology Department Centre Hospitalier de Versailles Le Chesnay Rocquencourt France

Hematology Oncology Universitätsklinikum Jena Jena Germany

Human Development and Health University of Southampton Southampton UK

IDIBAPS Hospital Clínic Barcelona Spain

Institute of Hematology Seràgnoli IRCCS Azienda Ospedaliero Universitaria di Bologna Department of Medical and Surgical Sciences University of Bologna Bologna Italy

IRCCS IRST Dino Amadori Meldola FC Italy

Karmanos Cancer Institute Wayne State University School of Medicine Detroit MI USA

Leukemia Department University of Texas MD Anderson Cancer Center Houston TX USA

Medizinische Fakultät Mannheim Universität Heidelberg Mannheim and ELN Foundation Weinheim Germany

Memorial Sloan Kettering Cancer Center New York NY USA

National Medical Research Center for Hematology Moscow Russia

Peking University People's Hospital Peking University Institute of Hematology Beijing China

Precision Cancer Medicine Theme South Australian Health and Medical Research Institute Adelaide and University of Adelaide Adelaide SA Australia

Princess Margaret Cancer Centre University of Toronto Toronto ON Canada

Servicio de Hematología HM Centro Integral Oncológico Clara Campal Instituto de Investigación Sanitaria HM Hospitales Madrid Spain

Translational Science and Therapeutics Division Fred Hutchinson Cancer Center Seattle WA USA

University Hospital Brno and Masaryk University Brno Czech Republic

University of Chicago Comprehensive Cancer Center Chicago IL USA

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