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The treatment of chronic myelogenous leukemia (CML) has been characterized in recent years by some of the most remarkable achievements in the treatment of cancer.1 Some of the best results obtained with allogeneic stem cell transplantation (SCT) have been reported in CML, and some of the leading observations that triggered our current knowledge about graft-versus-leukemia effect and the immunology of transplant were pioneered in CML. CML was probably also one of the first malignancies in which a biologic agent, interferon alpha (IFN-a), was able to eliminate the disease, substantiated by the achievement of a complete cytogenetic remission in a fraction of all patients treated. Most recently, the introduction of imatinib mesylate represents one of the best examples of a target-specific therapy that has resulted in complete responses for the majority of patients with this disease. The availability of several treatment modalities that may improve the survival of patients with any malignancy is welcome. The current challenge, however, is to learn to integrate these strategies in a way that will result in the greatest probability of long-term survival for most patients diagnosed with CML. It is no longer a matter of treatment options, but of treatment strategies. In this chapter, we will discuss the current treatment alternatives for patients with CML in chronic phase. This is an evolving field not free of controversy, and the major elements of this controversy will be discussed here. Although IFN-a has been largely replaced by imatinib as the centerpiece of the management of patients with chronic-phase CML, the lessons learned from IFN-a are important and will therefore be discussed first.

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