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How would you treat a patient who is in remission from CML but has positive cytogenetic and molecular tests?

June 1, 2023

June 2023

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.

Disclaimer: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is solely at your own risk.

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


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