Male patient, 50 years old at diagnosis, CML since 11/2019, initial CP, Ph pos, typical transcript, no comorbidities.
Started with nilotinib treatment 11/2019, BCR >1% after 1 Year (3.5%), Dasatinib not tolerated, switch to ponatinib 30mg 1/21 (within a study) increased to 45 mg 6/21 (BCR-ABL 0.5%)
As the BCR::ABL1 level increased in March this year (0.6%) a mutational analysis was performed in 2 labs . One lab detected the K245N mutation.
Since then BCR:ABL1 decreased to 0.2% but is stable for 3 months now, still no MMR.
We recommended an allo SCT as the mutation appeared. But only one donor with mismatch was detected. One son (17 years old) could be a haplo donor.
Patient’s wish is to try asciminib.
What would you do?