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Abstract This study was designed as a prospective, observational, non- interventional study. A total of 102 patients with chronic-phase CML treated with IM were enrolled. The study protocol was approved by the Institution Review Board (IRB) of the National Cancer Institute of Cairo University, Egypt. Adherence was monitored by using Morisky medication adherence scores (MMAS). Drug level and its metabolite as peak and trough concentration after reaching steady state and intracellular concentration were measured using high performance liquid chromatography mass spectroscopy (LC/MS/MS). Gene polymorphism was conducted using PCR-RFLP technique In patients with CML treated with IM the significant independent factor affecting response was P/T ratio. As the peak/trough ratio increase by one, the risk of bad response increase by more than double as compared to good response with 95% CI (1.28 {u2013} 3.92),( P = 0.005), ABCG2 G34A may influence the inter-individual variation in plasma IM concentration observed among Egyptian CML patients. Although a prospective study with a larger patient population is necessary to validate these findings, plasma IM concentration monitoring and clinical ABCG2 G34A and SLCO13 T334G genotyping may improve IM therapy for CML, particularly in Egyptian populations |