Successful management of Ph chromosome chronic myelogenous leukemia with leukapheresis during pregnancy

Bazarbashi, Maher; Smith, Mark; Karanes, Chatchada; I, Zielinski; Bishop, Carter R.

doi:10.1002/ajh.2830380316

Cited by 43 publications

(19 citation statements)

References 25 publications

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“…CML leads to increased risk of leukostasis and placental insufficiency resulting in intrauterine growth retardation, prematurity and hence increased fetal morbidity and mortality [16,17]. IUGR amongst our cases can be secondary to materno-placental insufficiency due to thrombotic complications.…”

Section: Discussionmentioning

confidence: 70%

Obstetric Complications and Management in Chronic Myeloid Leukemia

Rohilla

Rai

Yanamandra

et al. 2015

Indian J Hematol Blood Transfus

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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.

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Section: Discussionmentioning

confidence: 70%

Obstetric Complications and Management in Chronic Myeloid Leukemia

Rohilla

Rai

Yanamandra

et al. 2015

Indian J Hematol Blood Transfus

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“…Although it is unlikely for patients in persistent MMR/CMR to require treatment, if molecular progression is observed, treatment must be established immediately. Nonteratogenic treatments during pregnancy are not well defined but leukapheresis [13], hydroxyurea, and interferon alfa [14] in the second or the third trimester could be a safe option. At present time, there is no formal advice in the literature on how to manage these situations but it must depend on the response the patient had achieved.…”

Section: Discussionmentioning

confidence: 99%

Planned Pregnancy in a Chronic Myeloid Leukemia Patient in Molecular Remission

Pavlovsky

Giere

Thillo³

2012

Case Reports in Hematology

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Excellent response rates and a good quality of life have been observed since the introduction of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) treatment. Consequently, some challenges began to appear in CML women in child-bearing age wishing to become pregnant. Currently, many women around the world are in stable major/complete molecular response MMR/CMR (MMR: <0.1% BCR-ABL/ABL and CMR: undetectable BCR-ABL mRNA by RQ-PCR transcript levels on the international scale). The condition of stable MMR/CMR is linked to a long-term virtual absence of progression to the accelerated and blastic phase and to the possibility of stopping the TKI treatment with the maintenance of a condition of CMR in a proportion of cases. Imatinib teratogenic and prescribing information prohibits the use of it during pregnancy. We describe the case of a 36-year-old female patient with CML in chronic phase who stopped imatinib after 2 years in major molecular response (MMR) to plan a pregnancy. Molecular monitoring by RQ-PCR was performed quarterly. She achieved a safe pregnancy and delivery maintaining an optimal molecular response throughout the pregnancy. Isolated literature reports have been described, but no formal advice has been described at present time.

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“…Although the course of CML is typically indolent, there are rare instances when patients are severely symptomatic and therapy during pregnancy cannot be withheld. If left untreated, reported complications include leukostasis, placental insufficiency, low birthweight infants and prematurity 4 . Unfortunately, there are few case reports of therapy during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Chronic myelocytic leukemia in pregnancy: A case report describing successful treatment using multimodal therapy

Eskander

Tarsa

Herbst

et al. 2011

J of Obstet and Gynaecol

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Leukemia during pregnancy is rare, posing a complex series of questions, including appropriate therapy and maternal counseling. Management of chronic myelocytic leukemia (CML) during pregnancy is limited. Our patient presented at 30 weeks' gestation with anemia, leukocytosis, and a non-productive cough. Polymerase chain reaction performed on a peripheral blood sample confirmed presence of the breakpoint cluster region-Abl1 chromosomal translocation and the diagnosis of CML. Therapy included acute leukocytapheresis, followed by α-interferon and imatinib mesylate. The patient responded to treatment and delivered a viable female infant at term weighing 2613 g. Continued imatinib mesylate chemotherapy post-delivery resulted in complete clinical remission. Successful antepartum management of newly diagnosed CML is possible utilizing leukocytapheresis, α-interferon and, more recently, imatinib mesylate. Definitive treatment should not be delayed due to pregnancy.

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Successful management of Ph chromosome chronic myelogenous leukemia with leukapheresis during pregnancy

Cited by 43 publications

References 25 publications

Obstetric Complications and Management in Chronic Myeloid Leukemia

Obstetric Complications and Management in Chronic Myeloid Leukemia

Planned Pregnancy in a Chronic Myeloid Leukemia Patient in Molecular Remission

Chronic myelocytic leukemia in pregnancy: A case report describing successful treatment using multimodal therapy

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