Successful Childbirth in a Patient With Chronic Myelogenous Leukemia Treated With Imatinib Mesylate During Early Pregnancy

Abstract

Aims:To report a case of successful pregnancy in a patient with chronic myelogenous leukemia treated with imatinib mesylate for the fi rst 4 months of pregnancy.Results: Imatinib mesylate is potentially teratogenic and its use during pregnancy in humans can lead to abortion or development of fetal abnormalities in nearly 40% of fully reported cases. We report a case of a 28-year-old woman who delivered a healthy child of normal weight after having been treated with imatinib for Ph1-positive CML during the fi rst four months of her pregnancy. She refused advocated interruption and for the rest of the pregnancy was treated with interferon. The treatment was associated with a rapid 2-log increase in the leukemia clone measured by the real-time polymerase chain reaction. Reintroduction of imatinib after delivery resulted in achievement of the complete cytogenetic response again.Conclusions: We discuss possible strategies for successful management of pregnancy in CML patients treated with imatinib.

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“…A few, small human studies have been conducted in pregnant women receiving imatinib for an oncological condition. Imatinib was found in both umbilical cord blood and in placenta homogenate right after birth, but these findings did not correlate with any clinical signs of negative effects on the child (35,38). Imatinib may also potentially harm the vascular development in the placenta.…”

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“…However, there have been a series of case reports and small series reporting normal outcomes following pregnancies. [143][144][145][146][147][148][149][150][151] The largest compilation of clinical experience is from a retrospective chart review of 180 women exposed to drug during pregnancy; outcome data were available for 125.150 Of these, 50% delivered normal children and 28% had elective terminations (3 following the identification of abnormalities). Twelve infants had abnormalities identified, 3 with a similar complex of malformations.…”

Issues of Imatinib and Pregnancy Outcome

“…The literature describes several case reports of pregnancy outcome in women who conceived while taking imatinib but ceased treatment either in the first trimester or remained on drug throughout the pregnancy, with most reporting favorable outcomes. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Recently, full outcome data have been reported for 125 women from a total of 180 known to have conceived while on imatinib. These results have given considerable concern regarding drug safety (Table 1).…”