Obstetric Complications and Management in Chronic Myeloid Leukemia

Abstract

Chronic myeloid leukaemia (CML) is amongst the most common haematological malignancies encountered in adults. The younger age of onset and increased incidence of CML in Indians leads to higher chances of encountering it in pregnancy. Pregnancy in CML is a complex situation as first line therapy with tyrosine kinase inhibitors (TKI), is fraught with multiple fetal safety issues. The fetal aspects have been elucidated in literature, but there is scarcity of information on the obstetric outcome per se in presence of CML, excluding the influence of TKI. Obstetric outcomes of 5 pregnancies in four patients with CML are being reported. Literature on interplay of CML and bleeding or thrombotic manifestations is reviewed. The major complications encountered were antepartum (APH) and postpartum haemorrhage (PPH), preterm labour, intrauterine growth retardation and intrauterine fetal death. Patients in the reproductive age group with diagnosis of CML should be carefully counseled regarding the effect of disease and TKI on the maternal-fetal health. Bleeding complications, particularly APH and PPH may be encountered in CML patients. Close coordination of the obstetrician, haematologist, and neonatologist is required in managing these cases successfully. The need for absolute contraception till the remission of disease needs to be emphasized for further pregnancies.

Changing Times for the IJHBT

“…In this issue, Kumar et al [4] investigate growth impairment and short stature among children treated for acute lymphoblastic leukemia, while Rohilla et al [5] report on obstetric outcomes in women with chronic myelogeneous leukemia. Another tricky management issue is the judicious management of elderly AML or high-risk MDS, and this is addressed by a Turkey study which looks at epigenetic modifiers alone as well as in combination with low-dose cytosine arabinoside in such patients.…”

Pregnancy and myeloproliferative neoplasms : A retrospective monocentric cohort

“…20 The disease itself does not appear to increase thrombosis rate or other pregnancy complications when leukocyte count is below 100 Â 10 6 /L and platelet count below 500 Â 10 6 / L. 21,22 Otherwise at delivery, hemorrhagic complications can occur. 23 Furthermore, TKIs have shown teratogenicity in animals and humans. 4 In humans there are more spontaneous abortions than in controls and unusual congenital malformations.…”

“…These include craniosynostosis, hypoplastic lungs, duplex kidney, absent kidney, exomphalos, hemivertebrae and scoliosis. 23 Most of these malformations may be linked with platelet-derived growth factor receptor-alpha pathway, a tyrosine kinase blocked by TKI. This pathway is involved in neurological, vascular and bone development in utero.…”

CML in India: Are We There Yet?

“…A large percentage of patients belong to the third and fourth decade. This can severely impact the outcomes being economically productive age, different social/psychological needs and the challenges of TKI's impact on reproduction [4,5]. The disease biology in Indian patients may also be different owing to late presentation leading to greater high-risk patients, increased incidence of myelofibrosis, and increased number of accelerated/blast phase patients at diagnosis [4,6].…”

“…The adherence is also dictated by the side-effect profile of the TKI both perceived by treating physicians and the patients alike. Studies on the audiovestibular, secondary malignancies, mucocutaneous and obstetric side effects published from India did clear some myths about the overhyped Imatinib toxicity profile [5,[10][11][12][13].…”