A real- world experience with asciminib in elderly CML-CP patients intolerant to previous

Tyrosine kinase inhibitors (TKIs) have transformed the management of chronic myeloid leukemia in chronic phase (CML-CP). However, long-term therapy is often limited by intolerance, adverse events, and quality of life (QOL) concerns. Asciminib, is the 1st and only approved BCR. ABL1 inhibitor that works by STAMP (Specifically Targeting the ABL Myristoyl Pocket), has demonstrated efficacy and tolerability in patients previously treated with ≥2 TKIs. We report two elderly CML-CP patients with intolerance to multiple TKIs who achieved sustained responses with asciminib. A 60-year-old woman with CML-CP, diabetes, hypertension, and CKD. After intolerance to Dasatinib and Nilotinib (due to recurrent pleural effusion), she was switched to Asciminib in March 2025. Since then, her leukemia remains under complete molecular control, and her overall condition is stable with manageable comorbidities. A 77-year-old male with CML (chronic phase, November 2022) presented with weight loss, anorexia, and fatigue. Initial TKIs (Nilotinib, Dasatinib, Imatinib) led to cytopenias/intolerance, but since June 2024 on Asciminib 80 mg OD, he has achieved deep molecular response (BCR-ABL 0.139% as of July 2025) and remains clinically stable with manageable cytopenias. These real-world cases highlight the clinical utility of asciminib in elderly, comorbid CML-CP patients who are intolerant to the previous TKIs. Asciminib provided durable molecular responses and superior tolerability, consistent with trial data, and represents a valuable therapeutic option in this challenging patient population.