Successful Pregnancy and Delivery in a Patient with Chronic Myelogenous Leukemia (CML), and Management of CML with Leukapheresis during Pregnancy: a Case Report and Review of the Literature

Abstract

Although infrequently seen, the management of cancer during pregnancy can be difficult for patients, their families and physicians. The concomitant occurrence of pregnancy and chronic myelogenous leukemia is uncommon. We describe the successful management of a 26-year-old woman in the first trimester of her pregnancy with chronic myelogenous leukemia (CML) in chronic phase by using only leukapheresis. She was treated with leukapheresis until her delivery at 36 weeks of gestation. The procedure was without significant adverse effects on the patient or fetus. We applied a total of 15 leukapheresis treatments throughout the pregnancy. The patient gave birth vaginally to a healthy 2800 g boy at 36 weeks of gestation. We conclude that leukapheresis may provide an alternative treatment to chemotherapy, alpha-interferon or imatinib in pregnant patients with CML, particularly with concern over their potential teratogenic and other adverse effects.

Detection of BCR-ABL-Positive Cells in the Colostrum of a Pregnant Patient with Chronic Myeloid Leukemia

“…Several studies have reported favorable maternal and infant outcomes for pregnant CML patients treated with only observation, leukapheresis (13)(14)(15)(16) or interferon alpha (IFN-α) treatment. IFN-α, which has never been associated with teratogenicity in humans, seems to be the only safe treatment of pregnant CML patients (17).…”

Obstetric Complications and Management in Chronic Myeloid Leukemia

“…Diagnosis during pregnancy is usually delayed as early symptoms of CML are nonspecific [3]. Choice of treatment is influenced by the time of diagnosis, clinical stage of the disease and the toxic effects of chemotherapeutic agents on mother and child [4]. The present patients showed occurrence of hemorrhagic complications, with the first patient presenting with APH in both pregnancies and second patient with postpartum hemorrhage.…”

“…Leukaemias during pregnancy are primarily acute, two third being acute myeloid leukaemia (AML) and remaining one third acute lymphoblastic leukaemia (ALL). Annual incidence of CML in females ranges from 0.6 to 1.6 per 100,000 population [4]. The median age of CML in India is reported variably as 32-42 years, a decade younger than in Europe (55 years) and America (66 years) [1,5].…”

Therapeutic Efficacy of Leukocytapheresis in a Pregnant Woman with Refractory Adult-onset Still's Disease

“…LCAP has been performed in pregnant patients with chronic myeloid leukemia (24), RA (25) and UC (26,27), demonstrating its safety for both mothers and fetuses. However, LCAP can result in anemia.…”