Maternal, Fetal, and Neonatal Imatinib Levels With Treatment of Chronic Myeloid Leukemia in Pregnancy

Burwick, Richard M.; Kuo, Kelly; Brewer, Diana; Druker, Brian J.

doi:10.1097/aog.0000000000001972

Cited by 20 publications

(12 citation statements)

References 12 publications

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“…However, more recently it has been suggested that TKIs may be safe for use in the second or third trimester of pregnancy. Burwick and colleagues recently reported treatment of CML in pregnancy with imantinib initiated at the end of the second trimester, with no adverse outcome, despite high concentrations of imantinib being demonstrated in the neonate's urine. Unfortunately, large‐scale clinical studies confirming the safety of TKIs later in pregnancy are lacking, and there is a paucity of data regarding the use of bosutinib and ponatinib in that setting.…”

Section: Discussionmentioning

confidence: 99%

Management of chronic myeloid leukemia in the setting of pregnancy: when is leukocytapheresis appropriate? A case report and review of the literature

et al. 2017

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BACKGROUND: Chronic myeloid leukemia (CML) is a common hematologic malignancy; however, its occurrence during pregnancy is unusual due to its low prevalence in females of childbearing age. There are conflicting reports of how to best manage CML in pregnancy, particularly in the setting of leukocytosis. CASE REPORT: A 30-year-old female was diagnosed with CML at 18 weeks’ estimated gestational age. On initial presentation she reported fatigue, night sweats, and early satiety, and was found to have a white blood cell (WBC) count of 69.3 × 109/L and platelet count of 366 × 109/L. Her disease was managed during pregnancy using interferon-α alone despite persistent leukocytosis. CONCLUSION: CML may be effectively managed during pregnancy, even in the setting of leukocytosis, without the application of leukocytapheresis. Management relies not only upon the coordination of drug therapy and fetal monitoring, but requires close communication between multiple medical disciplines. Leukocytapheresis has been safely performed during pregnancy and may be a suitable adjunct management strategy in pregnant patients diagnosed with CML with specific clinical presentations, such as hyperleukocytosis (WBC count > 150 × 109/L) and/or symptomatic leukostasis.

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Section: Discussionmentioning

confidence: 99%

Management of chronic myeloid leukemia in the setting of pregnancy: when is leukocytapheresis appropriate? A case report and review of the literature

et al. 2017

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“…This approach has been challenged by the observation of hydrops fetalis in a woman who started dasatinib in the second trimester, 29 and supported by reports of detection of TKIs and their metabolites in cord blood, placental tissue, amniotic fluid, fetal plasma and neonatal urine. 9,16 It is therefore reasonable to avoid TKIs throughout pregnancy. If treatment is required then the options include leucapheresis, interferon and TKIs.…”

Section: Female Patientsmentioning

confidence: 99%

A British Society for Haematology Guideline on the diagnosis and management of chronic myeloid leukaemia

et al. 2020

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The management of chronic myeloid leukaemia (CML) has seen considerable change in the last several years. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of CML in adults and children. Methodology This guideline was compiled according to the British Society for Haematology (BSH) process described at http://www.b-sh.org.uk/guidelines. The Grading of Recommendations Assessment (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http:// www.gradeworkinggroup.org.

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“…The authors summarized information from 26 cases of imatinib use during pregnancy and noted no fetal abnormalities when the drug was started beyond the second trimester. A subsequent report by Burwick et al 28 described the use of imatinib at 28 weeks’ gestation for CML diagnosis in pregnancy, after failure of leukapheresis and IFN; complete hematologic response was achieved within 4 weeks. Normal childbirth was observed despite detection of residual levels of imatinib in placental tissue and amniotic fluid.…”

Section: Diagnosed During Pregnancymentioning

confidence: 99%

Tyrosine kinase inhibitors and pregnancy in chronic myeloid leukemia: opinion, evidence, and recommendations

Abruzzese

Mauro

Apperley

et al. 2020

Therapeutic Advances in Hematology

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With survival expectation that of age-matched controls and given excellent response and worldwide access to tyrosine kinase inhibitors (TKI), family planning is increasingly important for a considerable fraction of patients with chronic myeloid leukemia (CML). The potential for therapy discontinuation (“treatment free remission”) can afford the opportunity for a CML patient in deep response to plan and carry a pregnancy to full term without any therapeutic interventions. However, the reality of pregnancy desired or occurring when patients are not eligible for treatment-free remission raises the discussion of therapy choices during pregnancy. To date there are no official guidelines available to assist patients and clinicians with these decisions. This first position paper aims to analyze information published and presented surrounding this challenging area, with focus on different scenarios of disease burden and time from CML diagnosis, including CML discovered during pregnancy and pregnancy during CML treatment. An updated review, supported by data and presented together with authors’ joint recommendations, is aimed to counsel the practical management of CML patients and pregnancy.

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Maternal, Fetal, and Neonatal Imatinib Levels With Treatment of Chronic Myeloid Leukemia in Pregnancy

Abstract: Imatinib is effective for CML in pregnancy, but caution is warranted in light of potentially unrecognized fetal and neonatal effects.

Cited by 20 publications

References 12 publications

Management of chronic myeloid leukemia in the setting of pregnancy: when is leukocytapheresis appropriate? A case report and review of the literature

Management of chronic myeloid leukemia in the setting of pregnancy: when is leukocytapheresis appropriate? A case report and review of the literature

A British Society for Haematology Guideline on the diagnosis and management of chronic myeloid leukaemia

Tyrosine kinase inhibitors and pregnancy in chronic myeloid leukemia: opinion, evidence, and recommendations

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