Perioperative care of patients with chronic myeloid leukemia on tyrosine kinase inhibitors

Background/objectives Patients with chronic myeloid leukemia (CML) are increasingly undergoing surgical procedures as long-term survival improves with tyrosine kinase inhibitor (TKI) therapy. This narrative review aims to synthesize current evidence regarding perioperative risk assessment and management in patients with CML receiving TKIs. Methods A literature search was conducted using structured searches of PubMed, Scopus, Web of Science, and Google Scholar for studies addressing perioperative management, anesthesia, bleeding, thrombosis, wound healing, obesity, pregnancy, and drug interactions in CML. Original studies, retrospective cohorts, case series, case reports, and narrative reviews relevant to perioperative care were included. Results Available evidence demonstrated that perioperative risk in CML extends beyond routine hematologic parameters and is strongly influenced by TKI-specific toxicities and disease-related factors. Dasatinib showed the greatest association with platelet dysfunction and cytopenias, while nilotinib and ponatinib were linked to increased arterial and cardiovascular risk. Splenomegaly, obesity, bariatric surgery, and pregnancy further altered perioperative risk and TKI pharmacokinetics. Available evidence does not establish validated drug-specific preoperative TKI interruption intervals, and the decision regarding temporary interruption should therefore be individualized according to TKI-specific toxicity, disease status, and procedural risk. The review additionally identified clinically significant CYP3A4-mediated interactions with perioperative anesthetic, antimicrobial, and analgesic agents, suggesting preferential use of propofol-based induction and non-CYP-dependent opioids when feasible. Conclusions Perioperative management in CML requires individualized multidisciplinary planning integrating hematologic, anesthetic, surgical, and pharmacologic considerations to optimize surgical safety while maintaining disease control.