Building practical solutions for CML management in Latin America

Highlights from the 2026 iCMLf Latin American Regional Discussion Groups 

Introduction

The 2026 iCMLf Latin American Regional Discussion Group series brought together international and regional experts for three highly interactive webinars exploring key challenges in contemporary CML management. Across the series, discussions addressed four major topics: first-line therapy, local implementation of the ELN 2025 recommendations, overcoming challenges to treatment adherence, and optimising CML laboratory diagnostics.

Rather than focusing solely on published evidence, each session also incorporated practical clinical cases and real-world experiences, allowing participants to discuss how international recommendations can be applied within the diverse healthcare settings across Latin America. 

#1: First-line therapy – Is imatinib still the best frontline therapy?

The opening session examined whether imatinib should remain the preferred first-line treatment or whether newer TKIs should now be considered the standard for newly diagnosed patients. Rather than reaching a definitive answer, the discussion highlighted the importance of individualised treatment decisions according to patient characteristics, treatment goals and regional realities. 

Key discussion points

• Imatinib continues to provide outstanding long-term survival, supported by more than 25 years of clinical experience.
• Second-generation TKIs and asciminib achieve faster and deeper molecular responses, increasing opportunities for treatment-free remission (TFR).
• TFR has become an increasingly important treatment goal, particularly for younger patients, although only a proportion ultimately achieve successful discontinuation.
• Treatment selection should consider efficacy alongside safety, cardiovascular risk, adverse events, comorbidities and patient preferences.
• Cost and drug availability remain major determinants of frontline therapy across Latin America.
• Sequential use of TKIs remains an effective strategy where access to newer therapies is limited.

Take-home message: There is no single "best" frontline therapy for every patient. Optimal treatment should balance scientific evidence with individual patient factors and regional healthcare realities.

#2: ELN 2025 recommendations – What's most important for Latin America?

This session explored the practical implementation of the updated ELN 2025 recommendations within Latin American healthcare systems, highlighting both the opportunities and challenges associated with applying international guidelines in resource-variable settings. 

Key discussion points

• The ELTS score is now recommended as the preferred prognostic scoring system.
• Revised terminology ("favourable", "warning" and "unfavourable") better reflects modern treatment goals.
• Updated recommendations broaden eligibility for TFR while emphasising the need for reliable molecular monitoring.
• Clinical management should remain individualised, particularly for patients with warning responses at early molecular milestones.
• Management of accelerated phase disease and treatment-limiting cytopenias continues to require careful clinical assessment.
• Regional differences in access to both TKIs and molecular monitoring, influence implementation of the guidelines.

Take-home message: Guidelines provide an important framework for CML management, but successful implementation requires flexibility and adaptation to local clinical practice.

#3: Overcoming challenges to treatment adherence

The second part of Meeting 2 focused on one of the most important determinants of successful CML management: maintaining long-term adherence to TKI therapy. Through a series of patient cases, speakers explored the multiple factors influencing adherence and discussed practical interventions that can improve treatment persistence. 

Key discussion points

• Poor adherence is often multifactorial, involving psychological, social, treatment-related and healthcare-system factors.
• Young adults are particularly vulnerable to adherence challenges during periods of changing life circumstances.
• Chronic low-grade adverse events can significantly reduce long-term treatment persistence.
• Education and open physician-patient communication are essential for improving adherence.
• Family support, multidisciplinary care and digital reminder tools can help patients maintain treatment.
• Financial barriers and limited healthcare access continue to influence adherence across the region.

Take-home message: Improving adherence requires understanding the individual patient and addressing the underlying barriers rather than simply encouraging medication compliance.

#4: How to get the best out of the CML laboratory

The final meeting explored how high-quality laboratory diagnostics support optimal CML management. Through challenging clinical cases from Argentina and Ecuador, participants discussed molecular monitoring, mutation analysis and the importance of clear laboratory reporting. 

Key discussion points

• Diagnostic characterisation of BCR::ABL1 transcripts is essential to ensure accurate long-term molecular monitoring.
• Atypical transcripts may require personalised molecular assays to avoid false-negative monitoring results.
• Next-generation sequencing has an important role in investigating treatment resistance and kinase domain mutations.
• Access to molecular diagnostics remains variable across Latin America, highlighting the importance of regional collaboration.
• Standardised laboratory reports should include International Scale (IS) results, control gene copy numbers, molecular response category and previous results where possible.
• Close communication between clinicians and laboratories is essential to support treatment decisions.

Take-home message: High-quality molecular monitoring depends not only on accurate testing but also on clear reporting and close collaboration between laboratories and clinicians.

Conclusion

Across all three meetings, a consistent message emerged: while advances in CML management continue to expand therapeutic possibilities, successful patient management depends on adapting scientific evidence to the realities of everyday clinical practice.

By combining international expertise with regional experience and practical case discussions, the 2026 Latin American Regional Discussion Group series provided a valuable forum for sharing knowledge, addressing common challenges and identifying practical strategies to improve outcomes for patients with CML across Latin America.

Watch the full videos from the Latin American series here
All videos are available in both English and Spanish.