Would you add chemotherapy to a TKI in treating an elderly patient with de novo CML blast crisis?

Treating CML blast crisis is challenging in any patient and there is no standard of care. Generally, it is recommended to treat with both chemotherapy and a TKI. However, it is most important to adjust treatment to the patient. If a patient is frail and unable to tolerate chemotherapy, I don't think it is unreasonable to start treatment with a TKI alone (perhaps with hydrea if needed initially) and to monitor the patient closely. I would also have a low threshold to check ABL1 kinase mutational analysis to help guide treatment early on.

The only curative approach to this condition is with transplant; if a patient is unable to undergo transplantation, then TKI alone +/- low dose chemotherapy to maintain stability could be a reasonable appro...