Beyond survival in CML-unmet needs and ways to improve tolerability and quality of life.

Tyrosine kinase inhibitor therapy for chronic myeloid leukemia represents a unique and evolving paradigm of successful anticancer therapy-from achieving survival comparable with that of the general population to optimizing long-term treatment, tolerability, and quality of life. However, many challenges remain, including the risk of serious long-term toxicity resulting in increased morbidity, the persistent burden of low-grade adverse events affecting adherence and quality of life, the lack of a consistent definition of tolerability, limitations of available assessment tools, gaps in our understanding of the pathophysiology of adverse events, and suboptimal patient-physician communication, with physicians consistently underestimating the burden and severity of adverse events. Importantly, efficacy, safety, tolerability, adherence, and quality of life are closely interconnected. Therefore, improving safety, tolerability, adherence, and quality of life is of particular importance not only for patient's well-being but also for achieving and maintaining treatment efficacy, including safe and successful attempts at treatment-free remission. Strategies to address long-term therapy issues also include improved prevention and management of adverse events, dose modification, careful treatment switching, and optimization of frontline treatment as a cornerstone of better long-term outcomes.