OBJECTIVE: The use of imatinib mesylate as first line treatment in management of chronic phase chronic myeloid leukemia (CML) is controversial. The objective of this study was to examine significant influences on physician recommendation for imatinib mesylate in chronic phase CML patients. METHODS: Data were collected via e-mail and web-based survey from a random sample of 1100 hematologists/oncologists listed in the American Society of Clinical Oncology (ASCO) database. Rogers' model of adoption of innovations was used as the main framework for the study. A series of pre-tested vignettes varying patient age and disease severity were used to assess physician recommendations to treat with imatinib vs. bone marrow transplant. A visual analog scale was used to measure physicians' recommendations. The main survey procedure used a modified Dillman's method. Factor analysis was performed for appropriate measures. Multiple regression analysis was used to test the model. Based on the theoretical model, the categories of independent variables included: innovation characteristics, communication channels, physician characteristics, social system characteristics and control variables. A within subjects repeated measures analysis was conducted to study the influence of patient age and disease severity on physician recommendation. RESULTS: A total of 305 responses were received giving a response rate of 29%. The regression model was found to be significant (p <0.05). Perceived relative advantage of imatinib in efficacy, peer influence, past experience and academic affiliation were found to be significant positive influences. Specialty in bone marrow transplantation was found to be a significant negative influence. Physicians were found to recommend imatinib mesylate to a greater extent in patients at least 55 years old as compared to younger ones. CONCLUSION: Rogers' model of adoption of innovation is useful in explaining physician recommendation for imatinib mesylate. In addition, patient age is a significant influence on physician recommendation for imatinib mesylate.