We asked, and you answered! Here are the responses from this month’s “You Make the Call” question on treating a patient who is in remission from CML but has positive cytogenetic and molecular tests.
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I would change to another therapeutic line, such as asciminib. At 64.5%, the patient can transform to blast phase at any time.
Nizar Abdel-Samad, MD
New Brunswick, Canada
Since the disease is unresponsive to dasatinib in the absence of a T315I mutation and the patient has intolerance to nilotinib, I think there are two options: alloHCT (especially taking into consideration the hypocellular bone marrow) or asciminib. I would try asciminib first, and if the disease still does not respond, then proceed to transplant.
Mihai Sotcan, MD
Bucharest, Romania
I would change the patient to ponatinib and refer for alloHCT instead and proceed if a well-matched donor can be found.
Iliana Plaza, MD
Santa Fe, Argentina
I would perform a search for a bone marrow donor (related or matched unrelated), and in the meantime I would give the patient asciminib.
Deborah Rund, MD
Jerusalem, Israel
I would start ponatinib as a bridge to alloHCT.
Richard Lind, MD
Asheville, NC
After failure with two TKIs in a patient with chronic-phase CML, alloHCT is a therapeutic option. I would evaluate this patient for transplant.
William Marrero-León, MD
San Juan, Puerto Rico
I would switch to another TKI; however, he did not tolerate the nilotinib so that may not be feasible. If he is still cytogenetically positive at one year, I would search for an allogeneic bone marrow transplant.
Carole Hurvitz, MD
Marina Del Rey, CA
