13 years with CML, 5 years on imatinib, 8 years on nilotinib/tasigna (150 mg/day last 5 years, curent BCR ABL 0,006-june 2026), diagnozed with LPR from bile reflux, hard to manage, seems tasigna exacerbate simptoms, the gastroenterologits recomended to switch, the hematologits putt on the table two options:
1- generic dasatinib, in the past i failed generic imatinib and generic nilotinib(intolerance);
2-scemblix, third line treatment in my contry, if i chose it, i will never come back to dasatinib, only remaining third line drogs like bosutinib and ponatinib.
What would you choose???
Someone who has been on both?
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generic dasatinib or scemblix?
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Both dasatinib and asciminib are excellent drugs. Asciminib is at least as effective as dasatinib, and very likely more effective based on fairly recent data.
To me there is no bad option out of those choices medically speaking. But, if starting asciminib rules out dasatinib in the future there is some merit to following “the flowchart” and trying dasatinib first. I have taken both dasatinib (for a long time) and asciminib, and I do feel that asciminib is kinder on me than dasatinib was. But it’s just one person’s experience. Lots of people do really well on low-dose (50mg or less) dasatinib.
Out of interest, which country are you treated in? It’s an unusual sequencing of medication … bosutinib is typically in the same “generation” as nilotinib and dasatinib, and ponatinib is usually reserved for t315i and pre-transplant preparation.
One thing that might be important is that dasatinib does need an acidic stomach to work fully, but asciminib doesn’t have the same constraints. So if you need to take stomach acid reducing medication then that would have a big impact on your decision.
David.
I have been on both. and started on imatinib 1st April 2023.. switched to sprycel ma y 2024 because my bcr/able was not improving. and I developed a rash on imatinib.
2nd,I did well with side effects and my bcr/abl improved on 50 mg sprycel, from 5/1/2024 thru the year 2024. 1/1 2025, I switched to the generic of sprycel, dasatinib, per insurance and Medicare.
I started skipping heart beats and in January and in may my face swelled and I developed rash. I believed it petechiae, little vessels popping. took a month off tki's. started 40 mg asciminib/scemblix in June 2025 and I've had no serious side effects that warrant another prescription. my bcr/abl improved from 0.03 at start of scemblix to 0.003 in Sept. 2026. my bcr/able is non-detectable since Dec 2025. I have slowly weaned with doc's guidance to 20 mg 3 days on, 1 day off. I take the 20 mg 3 of 4 days. I wean simply so I can live my life with typical energy.
I do take supplements, with doc's knowledge.
I hope this has not been too hard to follow. I am a 1-finger typed. I am a dinosaur. my thoughts may become jumbled trying to think answers and type.
there is no need to reply. I will gladly answer your questions. I can be more specific in answering a specific question. help you look stuff up, help yourself.
I am 3+ yrs. diagnosed with cml, I am 74, very fit for an old man, take no other scripts besides the tki.
I was happy for the scemblix.
thank you for reading this.
Hello David, thank you for the answer, now im struggling to treat bille reflux ( I took out the gallbladder 12 yeras ago), which is more difficult to manage than gastric reflux, constant heat senzation in my neck its affects me mentally. Normaly bille reflux its not being treated with a antiacid, butt in this moment i dont now if in the reflux exist a acid component.
Here in Romania where i live, the treament plan for CML seems to by illogicaly, butt it's good that still exists. I now about 50 mg dasatinib dose it is just as effective as 100 mg, and i thik to cutt the pill in half. Normaly i would have chosen dasantinib, butt in this situation, hard choice..
Hello Bob, thank you for the answer, i m glad to hear like such a small dose of asciminib is it enough for you, butt since i was diagnozed, 13 yeras ago, i never passed a worse time than now, and my symptoms are not caused by TKI or CML, but of bile reflux, affection what it seems to lack a effective treatment.
It seems like dasatinib has strong side effects in low dose of 50 mg, and the generics are not as good as the original.
bile reflux-wise, you may be helped by this 4/17/2023 by a Dr. axe. the article is 4/17/2023, recent. I go to Dr. axe's site for advice regarding supplements for various things.
Acid Reflux Diet: Best and Worst Foods plus Supplements
Dr axe's site is legitimate.
I may be doing so well on scemblix/asciminib because it is not generic. I did notice my generic dasatinibs were coming from different manufacturers. the fillers in the med were different. I blamed my skipped heart beats and face swelling on the fillers. I had gotten down to 40 mg dasatinib and was doing well blood bcr/abl wise. I tolerated the skipped heart beats. but not the swollen face.
your doc mention fasting 2 -3 hrs before asciminib dose, 1 hr after. I take my pill at 1 am, middle of my sleep.