When oral medicines for Chronic Myeloid Leukemia (CML) first became available, they dramatically changed what it meant to live with the disease. What was once life-threatening became a condition patients could manage long-term. Survival, once the only goal, was suddenly within reach for most.
But two decades later, a new question has emerged: is survival enough? Increasingly, the answer is no. Patients and doctors are shifting the conversation from “how long can I live?” to “how well can I live?”
The Indian Context: Younger Patients, Bigger Expectations
In India, the CML story takes on unique dimensions. Patients are often diagnosed between the ages of 35 and 40—much younger than in the West. At this stage of life, people are in the middle of careers, family responsibilities, and personal milestones. For them, disease control is important, but so is the ability to work, to stay active, and to preserve emotional well-being.
Dr. Suresh. H. Advani, Director, Department of Medical Oncology at Jaslok Hospital & Research Centre, stated, “CML therapy is rarely a straight road. Some patients struggle to hit treatment milestones, and 30–40% stop their first-line therapy within five years due to intolerance or side effects. That clearly shows us why we need better solutions.”
Beyond MMR: Raising the Bar to DMR and TFR
For years, achieving a Major Molecular Response (MMR) was the benchmark of success. Now, doctors are aiming for something deeper—Deep Molecular Response (DMR). Why does this matter? Because DMR opens the door to Treatment-Free Remission (TFR), where patients can potentially stop medication while staying in remission under supervision.
For newly diagnosed patients, reaching DMR within the first two years greatly increases their chances of achieving TFR later. This isn’t just a medical milestone; it’s a path toward a future with fewer pills, fewer side effects, and more freedom. Take the story of Ramesh, a 38-year-old IT professional in Bangalore. Diagnosed with CML at the peak of his career, Ramesh initially struggled with side effects that impacted his ability to work and care for his family. By collaborating closely with his doctor, he switched to a newer therapy that offered fewer side effects. Today, Ramesh is not only thriving at work but is also hopeful about achieving TFR in the future.
The Unseen Burden of Side Effects
While tyrosine kinase inhibitors (TKIs) remain the backbone of treatment, their benefits often come with hidden costs. Low-grade but persistent side effects—such as fatigue, joint pain, and digestive issues—are reported by nearly all patients in Indian studies.
These issues don’t always result in hospital visits, but they do affect how patients work, travel, and engage with family. Over time, they can also drive dose reductions, therapy switches, or discontinuation altogether. For young patients looking at decades of treatment, tolerability becomes as critical as efficacy.
A New Benchmark: Efficacy With Tolerability
Today’s CML patients are asking more than, ‘Is my disease under control?’. They want to know, ‘Does this treatment allow me to live the life I want?’ That balance of safety, efficacy, and quality of life is becoming central to treatment decisions.
This is where newer therapies are beginning to change the narrative. Designed to minimize off-target toxicity while maintaining or even improving outcomes, these treatments are redefining what’s possible—offering patients the chance to reach deeper responses without being weighed down by side effects.
Looking Forward: Shaping the Future of CML Care
As treatment goals evolve, so must the dialogue between patients and their doctors. Clear conversations about milestones like DMR and the potential for TFR can empower patients to see beyond survival and actively plan for a future that includes both health and independence.
The story of CML is no longer just about turning a fatal disease into a chronic one. The next chapter is about helping patients live fully—measuring success not just in years of life gained, but in the quality of life preserved.