The recent 2020 update to the European LeukemiaNet (ELN) recommendations provided insights from new developments and research which have led to changes in the landscape of chronic myeloid leukaemia (CML) treatment. Difficult cases, resistant to an initial second-generation tyrosine kinase inhibitor (TKI) given either as first- or second-line therapy, are now known to be unlikely to have a durable response to an alternative second-generation TKI. The panel recommendation is that these patients, without specific mutations or cardiovascular risk factors, should be started on a third-generation TKI like ponatinib.
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