I agree the best approach is imatinib and would try that first with close monitoring and aggressive management of fluid retention if it occurs. Asciminib is a good choice. ADCEMLE showed higher frequency of aretrio-occlusive events than Bosutinib but still a low rate (aprox. 3%). This is a good option. There is an expanded access program but it requires approval of a study. If it is an option, we have the study open. It is very flexible so after enrollment, visits can be done mostly locally and minimally here. I have not tried asciminb on a patient with PAH but I would consider it a safe alternative, perhaps safest after imatinib with the information available to date (granted, not as much information as with the other TKI). Alternatively, nilotinib can be considered. I would use a low dose of 50 mg to start and monitor. It is true that it has risk of arterio-occlusive events but it is no higher than dasatinib, but PAH has not been nearly as common.
Does anyone have relevant experience of:
(1) observed pulmonary arterial hypertension develop in a patient taking asciminib OR
(2) switched a patient with PAH onto asciminib