OBJECTIVES: While BMT is the only potentially curative treatment for CML, patient eligibility is limited and morbidity risks are common. Imatinib (IM) is the current treatment of choice for many patients with CML. This literature review compared the clinical and economic outcomes attributable to first-line treatment for chronic phase CML with IM and BMT. METHODS: A systematic review of published literature was undertaken using Medline. The search terms focused on IM and BMT as well as epidemiology, morbidity, mortality, quality of life and cost-effectiveness. The search of English language papers was undertaken from 1997 to the present. A manual literature search was also undertaken, identifying further articles from citations in published papers. RESULTS:  Twenty-nine relevant publications were identified providing data on at least 4,931 IM-treated patients and 1,699 patients who received BMT (sample size was omitted in some instances).  The probability of mortality in year 1 was estimated to be ~28% and 0% among those who received BMT and IM respectively. Use of IM relative to BMT in chronic phase CML is also expected to lead to increased rates of complete haematologic and cytogenetic response, higher short-term overall survival and event-free survival. Moreover, IM is associated with fewer haematological complications such as chronic and acute graft versus host disease and a greater proportion of IM-treated patients are expected to be free from disease progression.  IM treatment compared with transplant resulted in an incremental cost saving of $5000 per surviving patient after approximately 2-4 years of follow-up. CONCLUSIONS: Published evidence supports the use of IM in patients eligible for transplant. In the short-term, imatinib appears to be a clinically more effective, better tolerated, cost-effective treatment compared to BMT in the management of chronic CML. However, longer-term published data are lacking.