Introduction: Most existing evidence on Chronic Myeloid Leukemia (CML) comes from high?income countries which focuses on survival, molecular response, and mutational analysis. Given that optimally treated CML patients in such settings can attain near?normal life expectancy, there is a clear need to investigate treatment availability, adherence, and survival outcomes in lower?middle?income countries (LMICs), where access, monitoring, and health?system constraints may prevent similar benefits. Cohort?based research is crucial to understand the burden of CML in real?world settings where comprehensive data are scarce. The Bangladesh Research on Advanced Clinical Evidence – CML (BRACE?CML) study is a hospital?based cohort established to investigate clinical, socioeconomic, behavioral and molecular determinants of outcomes in CML patients in Bangladesh.

Objectives: To determine survival outcomes and identify the clinical, socioeconomic, behavioral and molecular predictors of mortality risk among CML patients in Bangladesh. Here, we are describing the baseline characteristics of the cohort.

Methods: This baseline study enrolled 134 patients (aged ≥18 years) on tyrosine kinase inhibitor (TKI) therapy for at least three months. Participants were recruited from the Department of Hematology outpatient clinic at the National Institute of Cancer Research & Hospital (NICRH), Bangladesh, between October and November 2025. Trained physicians administered a structured questionnaire to collect demographic, socioeconomic, behavioral, and clinical data. Anthropometric and blood pressure measurements were recorded for each participant. Blood samples from patients with warning signs were collected for BCR-ABL kinase domain mutation analysis for TKI resistance.

Results: The median age of respondents was 40 years (IQR: 33–51) where 66.42% were male and 90.08% were married. Approximately 28.36% participants had no education, and only 7.4% had a university degree. The median monthly family income was 15,000 BDT (IQR: 12,000–25,000) with an average family size of 4.68 members where only average 1.14 were earners.[AD2]  Most patients were in the chronic phase (86.92%). The median time since diagnosis was 4.17 years (IQR: 2.10–7.5); treatment delay was negligible (median 0 days). Clinically, 71.76% had mild restriction and 10.69% fully active; the rest were ECOG 2–4. Normal BMI was 61.94% and underweight 10.45%. Comorbidities were present in 47.01%. Hematological response was absent in 35.82%, and 89.55% complained about different degree of symptoms. TKI adherence (MMAS-8) was low: 52.24%, and 47.76% reported irregular intake due to drug supply interruptions. Perceived social support (MSPSS) was low-to-moderate in 61.65%. Finally, 85% desired more information on the disease, side effects, and impact on quality of life.

Conclusion: This study demonstrates an early onset CML in Bangladesh and a high proportion do not exhibit hematological response to treatment. The findings exhibit critical percentage in low medication adherence even when the drug supply was available. From advanced analysis, a key evidence-based goal is to develop a sustainable, hub-and-spoke model of drug supply to ensure continuum of care across divisions, as patients seeking free drugs primarily attend NICRH, country's single government cancer center. Outcomes vary at other tertiary hospitals and thus, we aim to expand the cohort across multiple centers in the future to capture a comprehensive national perspective in Bangladesh.