We retrospectively compared the efficacy and safety of frontline imatinib between elderly patients (>= 60 years old) and younger patients ( <60 years old) with chronic myeloid leukemia (CML). Response rates were similar in both groups. Event-free survival was comparable, and overall survival-when non-CML-related deaths were censored-was also similar. Age at diagnosis and the Charlson comorbidity index were significantly associated with overall survival. In the era of tyrosine kinase inhibitors, survival of patients with CML is determined more by comorbidities than by the disease itself.