Chronic myeloid leukemia in resource-limited settings: Navigating treatment challenges amid limited tyrosine kinase inhibitor access

Objectives Chronic myeloid leukemia presents unique management challenges in resource-limited settings such as Pakistan, where access to advanced molecular monitoring and newer tyrosine kinase inhibitors remains limited. This study evaluates the outcomes in patients with chronic myeloid leukemia in Pakistan, where first-generation tyrosine kinase inhibitors remain the primary mode of treatment due to the lack of newer interventions and insufficient molecular surveillance facilities. Methods This retrospective cohort study analyzed 73 patients with chronic myeloid leukemia treated at the Indus Hospital and Health Network, Karachi, Pakistan, between 2018 and 2025. Patients were stratified according to the European Treatment and Outcome Study long-term survival score, and treatment responses were compared using hematologic and molecular remission. Results The proportion of males and females was almost equal. Conventional karyotypes were observed in 92.9% of cases. With imatinib as the first-line therapy, optimal response and treatment failure was observed in 31.3% and 45.3% cases, respectively. A lower complete hematologic response was associated with intermediate-risk scores and atypical fluorescence in situ hybridization results. The intent to change therapy was found to be a powerful predictor of better overall response (adjusted odds ratio: 23.620, p -value: 0.0001). Only two patients transitioned to blast crisis. Conclusion Although there are promising trends of improvement in progression-free survival, the high rates of treatment failure as well as the lack of access to advanced treatment regimens and monitoring remain major concern. Strengthening public–private collaborations and international partnerships is essential to ensure equitable access to advanced therapies and improve long-term outcomes in patients with chronic myeloid leukemia in low- and middle-income countries.