LAUSR

There is currently little information on the upfront use of low‐dose ponatinib (15 mg once‐daily) for patients with chronic phase chronic myeloid leukemia. And yet, the concept carries immediate clinical relevance because of the association between the standard ponatinib starting dose of 45 mg once‐daily and the now infamous ponatinib‐ induced arterial vascular events. Whether or not low‐dose ponatinib is safer in this regard requires prospective testing, but the possibility has been suggested in a recent abstract where efficacy was sustained after dose reduction in clinical trial patients. A 31‐year‐old man with chronic phase chronic myeloid leukemia, diagnosed in January 2007, received treatment first with imatinib (February 2007), followed by dasatinib (November 2013) and bosutinib (June 2015), and ultimately ponatinib at 15 mg/day (September 2016); detailed account of the treatment history is outlined in Table 1. Although the patient managed to achieve complete cytogenetic response with each one of these tyrosine kinase inhibitors, major molecular response (MMR) was documented only with ponatinib (Table 1). Furthermore, the responses to second‐generation (2G)‐tyrosine kinase inhibitors, including those of dasatinib and bosutinib, lasted for less than 1 year (Table 1). Nilotinib was considered before starting ponatinib but patient refused because of arterial vascular event concerns and the presence of kinase domain mutations (KDM) (Table 1). Low‐dose ponatinib (15 mg once‐daily) enabled achievement of MMR+, which has been sustained so far for over 1 year (Table 1).