The outcome and quality of life of chronic myeloid leukemia (CML) patients has 
remarkably changed with the treatment of tyrosine kinase inhibitors (TKIs). 
Currently, hematopoietic stem cell transplantation (HSCT) is considered mainly 
as a third line salvage therapy in cases of TKIs resistance or intolerance. Here 
we describe a patient with chronic phase CML who developed both resistance and 
late occurrence of s severe thrombo-cytopenia on first and second generation 
TKIs and eventually underwent HSCT. Although the mechanism of the 
myelosuppression is not fully understood, we showed for the first time the 
development of dose dependent platelet antibodies in the presence of TKIs, 
suggesting the possibility of TKIs induced thrombocytopenia. Our case emphasizes 
that late development of severe myelosuppression during imatinib treatment is 
probably an important indication for consideration of early HSCT.