I was hoping to get some assistance about a complicated patient.
64Y AA with bilateral hearing loss, tinnitus. He was diagnosed with CML-CP 18 months ago and his baseline transcript level at was 43.1% and he was started on Dasatinib 50mg/day given tolerability concerns. His baseline BM showed grade 2 fibrosis and 7.5% blasts. At the 6.5 month, despite not reporting any missed doses, he lost his CHR and his ABL-PCR-b2a2 was 73%, (lowest was 16.25%). Repeat BM eval demonstrated showed ABL1 T315I, SUZ12 R121 and KMT2D R1219Q. No evidence of clonal evolution. He was started on ponatinib 45mg daily. Unfortunately, his transcript levels kept increasing to 74.35% without reaching hematologic remission, after being on therapy for 3 months. Due to concerning progression, he was started on Asciminib 200mg bid on 11/22/2021 and his transcript levels are unchanged at 3 months.
The patient has social barrier to getting an allo-transplant for several reason. Wanted to get advice on further management of this patient. Is there any evidence of adding any agent to Asciminib ? would you advice trying hydra and IFN?