This is a complicated case. The presence of extramedullary disease establishes the diagnosis of blast phase. This patient thus needs a different therapy. I would consider using AML-like chemotherapy in combination with a TKI. For the chemotherapy, we have used low-dose ara-C-based combination with low-dose idarubicin in some patients with good success. Although if patient is in good overall condition, perhaps a higher-dose ara-C regimen is a better option. For the TKI I would consider bosutinib or dasatinib at this time. It is also important to consider DLI or a second transplant. Unfortunately these instances of isolated extramedullary disease can be difficult to treat and you frequently end up chasing the tumors. Local radiotherapy may help eliminate the current lesion, but is not enough for long-term control of the disease.