Treatment of chronic myeloid leukemia (CML) patients using imatinib alone is unlikely to be curative. The challenges in the era of imatinib are to prevent the emergence of imatinib resistance and to identify the most effective alternative approaches for patients who lose imatinib responsiveness. This review describes the possible strategies to overcome imatinib resistance in CML patients based on the current understanding of the action of imatinib and mechanisms of its resistance. The useful laboratory tests to study imatinib resistance and a current Australian CML study employing imatinib dose intensification and sequential combination therapy for newly diagnosed patients are also outlined.