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ELN CML Milestones

ELN CMLMolecular Milestone Assessment

TKI Response Metrics

% (IS)

Awaiting Molecular PCR

Enter the molecular response to see if the patient is hitting the ELN targets.

Targets (Optimal)

  • 3 Months: <= 10%
  • 6 Months: <= 1%
  • 12 Months: <= 0.1% (MMR)
Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Clinical Use

Monitoring patients with CML in Chronic Phase on any TKI (Imatinib, Dasatinib, etc.).
Dictating when to switch TKIs or perform BCR-ABL1 kinase domain mutation analysis.
Requires quantitative RT-PCR for BCR-ABL1 transcripts expressed on the International Scale (IS).

How it Works

ELN Milestones (BCR-ABL1 IS %)

TimepointOptimalWarningFailure
3 Months≤ 10%> 10%N/A (check again at 6mo)
6 Months≤ 1%> 1 - 10%> 10%
12 Months≤ 0.1% (MMR)> 0.1 - 1%> 1%
Any timeMaintenance of MMRLoss of MMRLoss of CHR or CCyR

Clinical Pearls

The 3-Month Early Molecular Response (EMR)

Achieving ≤ 10% at 3 months (EMR) is one of the strongest predictors of long-term overall survival and progression-free survival. Patients who fail to reach this milestone should be evaluated for adherence and potentially considered for a switch to a more potent 2nd generation TKI.

Failure vs. Warning

A "Failure" designation necessitates an immediate change in management (e.g., bone marrow biopsy and mutation testing). A "Warning" designation suggests closer monitoring (e.g., every 1-2 months) to see if the patient recovers the optimal trajectory.

The Evidence

Key Reference

European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia

Hochhaus A et al. • Leukemia. 2020;34(4):966-984

Last Comprehensive Review: 2026

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Recent Journal Updates

British J HaematologyJul 22, 2026
Avatrombopag for persistent and chronic immune thrombocytopenia in children: A post hoc analysis of clinical characteristics of response from a phase 3b clinical trial

Clinical Context

We think this might be relevant to the clinical guidance for ELN CML Response Milestones.

PLOS MedicineJul 22, 2026
Whose fears count? Legitimacy, trust and viral outbreak responses after COVID-19

Clinical Context

We think this might be relevant to the clinical guidance for ELN CML Response Milestones.

WHO NewsJul 15, 2026
Global childhood immunization coverage inches forward despite conflict and hesitancy – UNICEF, WHO

Clinical Context

We think this might be relevant to the clinical guidance for ELN CML Response Milestones.