Hi Nobuko,
Very difficult case. It looks like he will not sustain a good molecular response to asciminib but I would probably watch for a few more months to be sure. If he is losing response to asciminib, which looks likely, and given the less than ideal donor, I would be thinking about ponatinib (45 mg/day with reduction to 15mg/day if/when he achieves MR2) as a last chance before considering the transplant option. Before stopping the asciminib it would be important to screen for kinase domain and myristoyl site mutations. Any single mutation should not represent a problem for ponatinib but if he has compound mutations, ponatinib may not be a good option – depending on the actual mutations.
Cheers - Tim