Nilotinib‐Induced Unilateral Renal Artery Stenosis: A Complication Prompting Treatment‐Free Remission in Chronic Myeloid Leukemia

Renal artery stenosis (RAS) is a rare but significant vascular complication associated with nilotinib therapy for chronic myeloid leukemia (CML). We present the case of a woman in her mid‐70s on long‐term nilotinib who developed this adverse event. The patient presented with a progressive, insidious decline in renal function over several years. Diagnostic evaluation revealed severe unilateral stenosis of the left renal artery. Under nilotinib, the patient had maintained a sustained deep molecular response (DMR), making her a candidate for treatment‐free remission (TFR). The development of RAS prompted the discontinuation of nilotinib, both as a therapeutic intervention for her kidney disease and to initiate a trial of TFR. Following discontinuation, the patient’s renal function showed partial but significant improvement, suggesting a causal relationship. This case describes the importance of recognizing subtle presentations of TKI‐induced vascular complications, particularly unilateral RAS, and illustrates how managing such adverse events intersects with modern CML therapeutic goals like TFR.