Opening the Debate: iCMLf Latin American Regional Discussion Group Kicks Off the 2026 Series
The 2026 iCMLf Regional Discussion Group series is underway. The first Latin American session convened international and regional experts for a lively debate on one of the central questions in CML management: is imatinib still the best frontline treatment?
This opening meeting marks the start of nine discussions planned across three regions over the coming months, with three sessions each dedicated to Latin America, South Asia, and Africa. Grounded in region-specific evidence and real-world practice, the discussions aim to foster meaningful dialogue and advance outcomes for people with CML across diverse healthcare settings.
This debate brought together Professor Giuseppe Saglio (Italy) and Professor Ehab Atallah (USA) as international faculty, alongside regional experts Dr Virginia Abello (Colombia) and Dr Katia Pagnano (Brazil). Active participation from attendees was a hallmark of the session, with discussion spanning scientific evidence and the practical challenges specific to Latin American clinical contexts.
With simultaneous translation provided throughout, there were 45 participants from 13 countries, reflecting the breadth of engagement the Regional Discussion Group series consistently attracts. The quality of discussion and the diversity of perspectives represented offered a compelling start to the 2026 series, and we are grateful to all four speakers for their contributions. The next Latin American session will follow shortly (details below), with South Asia and Africa joining the conversation in the months ahead.
Key discussion themes
1. Efficacy versus long-term outcomes
A central point of debate was whether newer tyrosine kinase inhibitors (TKIs) offer meaningful advantages over imatinib. While second-generation TKIs and newer agents such as asciminib achieve faster and deeper molecular responses, participants emphasised that overall survival remains comparable across therapies. Imatinib’s long-term data, spanning over 25 years, continues to demonstrate survival rates approaching those of the general population, reinforcing its reliability as a frontline option.
2. Treatment-free remission as a key treatment goal
The discussion highlighted the growing importance of treatment-free remission (TFR) as a treatment objective, particularly for younger patients with CML. Experts opposing imatinib as the best front line therapy argued that faster and deeper responses with second-generation TKIs increase the likelihood of achieving TFR. However, it was also noted that only a subset of patients ultimately reach and maintain TFR, and expectations must be managed carefully in clinical practice.
3. Tailoring frontline therapy to safety profile and patient characteristics
Choosing frontline therapy requires careful consideration of side-effect profiles and individual patient characteristics. Imatinib was recognised for its favourable cardiovascular safety profile, while second-generation TKIs are associated with higher risks of specific toxicities
(e.g., cardiovascular events or pleural effusion). The discussion emphasised tailoring treatment decisions to comorbidities, age, and patient preferences rather than adopting a one-size-fits-all approach.
4. Cost, access, and real-world constraints
Cost and drug availability remain critical factors in Latin America. Imatinib, particularly in generic form, was widely acknowledged as the most cost-effective option, enabling broad access. However, variability in generic drug quality and availability was raised as a concern, with some clinicians reporting differences in tolerance and response. The high cost of newer agents, especially asciminib, continues to limit their widespread use despite promising efficacy.
5. Treatment sequencing and switching in clinical practice
Real-world data from the region suggest that a significant proportion of patients starting on imatinib eventually switch therapies due to resistance or intolerance. This raises questions about whether initiating treatment with more potent agents could reduce switching and improve long-term outcomes. Conversely, others argued that having multiple effective options allows for flexibility, and sequential therapy remains a viable strategy.
Conclusion
The debate underscored that while imatinib remains a cornerstone of CML treatment, particularly in settings where cost and long-term safety are key considerations, newer therapies are reshaping expectations around treatment depth and the possibility of TFR.
Rather than a definitive recommendation, the discussion highlighted the need for a balanced, patient-centred approach that considers both clinical evidence and regional realities.
The session set a strong foundation for the Latin American series, with upcoming meetings continuing to explore key challenges in CML management across the region.
You can view the videos of the complete discussion, including the Spanish interpretation on our YouTube channel
Upcoming Regional Discussions:
Latin America
Meeting 2: 21st May
- ELN 2025 recommendations - what’s most important for Latin America?
Speakers: Jorge Cortes (USA) and Lilian Pilleux (Chile)
- Overcoming challenges to treatment adherence
Speakers: David Yeung (Australia) and Ana Ines Prado (Uruguay)
Register here:
Meeting 3: 2nd July
How to get the best out of the CML laboratory
Speakers: Sue Branford (Australia) and Isabel Giere (Argentina)
Register here:
South Asia
Meeting 1: 3rd June (SAVE THE DATE)
First line therapy - is imatinib still the best frontline treatment
Speakers: Hemant Malhotra (India) and Susanne Saussele (Germany)
Mehreen Ali Khan (Pakistan) and Gianantonio Rosti (Italy)
Meeting 2: Wednesday 8th July (SAVE THE DATE)
- ELN 2025 recommendations - Key changes that will impact CML treatment in South Asia?
- Overcoming challenges to treatment adherence
Meeting 3: 9th September (SAVE THE DATE)
- Managing resistance to treatment
- Managing serious adverse events in chronic phase CML patients
