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Normal hemopoiesis has not recovered for whatever reason and what does recover here is clonal. All the TKIs are good at shutting down the CML clonal hemopoiesis and switching will not change things. Persistent cytopenias is one of the very few indications for stem cell allografting and as I pointed out in a very recent commentary in Am J Hem, nothing will be gained by delaying and the risk of cytopenia related problems can only get worse. This is a young man and should have a good transplant outcome. I agree with Tim, but would not delay.
Thank you Prof for the comprehensive analysis of the situation. I am from Uganda and we face such challenges. However, I wish to be enlightened on why the first line treatment was dasatinib and at a high dose. I think we have not identified any ABL1 mutations in this young patient but what would be the role of other lines of treatment? I am asking this because in low income settings access to Allotransplants is not possible.
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