Within the MATCHPOINT clinical trial, we started ponatinib 30mg on day 1 of induction chemotherapy (FLAG-IDA). We continued the ponatinib until day 28 of each cycle. If there was no count recovery by day 28, then the ponatinib was stopped, and then re-started once counts had recovered (grade 2 or better). The ponatinib (at a dose of 30mg if not in CCyR) or 15mg if in CCyR was then continued until admission from conditioning for alloSCT. Where possible, ponatinib 15mg was re-started post SCT.
In this case, I would stop the ponatinib if grade 3 cytopenias are continuing, until resolved to grade 2 or better (Plt>50x10^9/L and Neut >1x10^9/L. For this patient, given their age, if they are fit enough and have a suitable donor, then I would proceed to alloSCT, even if only minimal cytogenetic response to the second DA3+7 with ponatinib. If there is no transplant option or this is delayed, and the patient isn’t in CCyR, then I would repeat a mutation screen and aim to give the patient ponatinib 45mg.
I am happy to discuss further.