Two successful pregnancies in a chronic myeloid leukemia patient treated with imatinib

Garderet, Laurent; Santacruz, Rodrigo; Barbu,; J, Van den Akker; Carbonne, Bruno; Nc, Gorin

doi:10.3324/haematol.10935

Cited by 31 publications

(14 citation statements)

References 9 publications

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“…We recognize that similar exposure to TKIs may be inadequate for patients with more extensive disease. However, this case and other recent reports [20–22] show that successful outcomes are possible for women with chronic phase CML during pregnancy.…”

Section: Discussioncontrasting

confidence: 49%

Successful Pregnancy and Delivery in a Patient with Chronic Myeloid Leukemia while on Dasatinib Therapy

Conchon

Sanabani

Serpa

et al. 2010

Advances in Hematology

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Here we report the case of an 18-year-old woman with chronic myeloid leukemia (CML) who became pregnant while undergoing treatment with dasatinib. Before pregnancy, she received imatinib mesylate therapy but could not tolerate the treatment. The regimen was then changed to dasatinib at a dose of 70 mg b.i.d. While she was in hematological remission and on dasatinib therapy, she became pregnant. The unplanned pregnancy was identified after the patient had experienced four weeks of amenorrhea. Because the patient elected to continue the pregnancy to term, dasatinib was stopped immediately. Meanwhile, CML hematological relapse occurred and then she was treated with interferon-α (IFN-α) (9 million IU/day) throughout the pregnancy without a complete hematological response. She successfully gave birth to a male baby at 33 weeks by cesarean section delivery with no sequelae or malformations. Although this experience is limited to a single patient, it provides a useful contribution for counselling patients inadvertently exposed to dasatinib during pregnancy.

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Section: Discussioncontrasting

confidence: 49%

Successful Pregnancy and Delivery in a Patient with Chronic Myeloid Leukemia while on Dasatinib Therapy

Conchon

Sanabani

Serpa

et al. 2010

Advances in Hematology

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“…In animal studies, imatinib was found to be teratogenic in mice but not in rabbits and these abnormalities are postulated to be as a result of PDGFRA inhibition. 80 The duration of imatinib therapy was not known in all of the affected cases described and as such it is not possible to predict an exact correlation between cumulative TKI dosage and the development of congenital abnormalities. In cases where conception has occurred on imatinib, imatinib should be stopped and close monitoring of fetal development should be recommended, including a nuchal scan for fetal anomaly, regardless of maternal age.…”

Section: Chronic Leukemias Chronic Myeloid Leukemiamentioning

confidence: 99%

How I treat leukemia during pregnancy

Milojković

Apperley

2014

Blood

123

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Leukemia in pregnancy remains a challenging therapeutic prospect. The prevalence is low at ∼1 in 10 000 pregnancies, and as a result data are limited to small retrospective series and case reports, rendering evidence-based recommendations for management strategies difficult. The management of the leukemias in pregnancy requires close collaboration with obstetric and neonatology colleagues as both the maternal and fetal outcomes must be taken into consideration. The decision to introduce or delay chemotherapy must be balanced against the impact on maternal and fetal survival and morbidity. Invariably, acute leukemia diagnosed in the first trimester necessitates intensive chemotherapy that is likely to induce fetal malformations. As delaying treatment in this situation is usually inappropriate, counseling with regard to termination of pregnancy is often essential.For chronic disease and acute leukemia diagnosed after the second trimester, therapeutic termination of the pregnancy is not inevitable and often, standard management approaches similar to those in nongravid patients can be used. Here, the management of the acute and chronic leukemias will be addressed. (Blood. 2014;123(7):974-984)

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“…Nevertheless, interferon maintained the complete hematologic response and the course of pregnancy was uneventful apart from terminal placental insuffi ciency. The baby was delivered without any problems, was normal on clinical examination and its weight was normal as in cases where IM was terminated immediately after confi rmation of the pregnancy 2,4,6 . Our case, along with the others reported to date, provides evidence that the embryo/fetus may not be aff ected by IM in all cases.…”

Section: Discussionmentioning

confidence: 97%

“…In animal studies in rats but not rabbits, however, IM exerts potential teratogenicity and, consequently, contraception has been strongly recommended in all women with childbearing potential during IM therapy 1 . Occasional cases of conception or successful pregnancy during IM treatment have however been reported in the literature, mostly as case reports [2][3][4][5][6][7][8][9][10] . In two of the four reported cases treated with IM for the whole duration of pregnancy, delivery of low-weight children were found 3,9 .…”

Section: Successful Childbirth In a Patient With Chronic Myelogenous mentioning

confidence: 99%

“…Therefore, after initial treatment with hydroxyurea, the patient was given the option of collecting her peripheral stem cells for the purpose of autologous peripheral stem cell transplantation later in the course of disease according to the results of conservative treatment. She gave her consent and fi ve months later she was primed with mini-ICE (idarubicin 15 mg, etoposide 250 mg and cytarabine 1.4 g for 3 days) and G-CSF and has collected 7.817×10 8 /kg MNC and 1.97×10 6 /kg CD34+ cells in fi ve aphereses. The graft was positive for Bcr-Abl by nested RT-PCR (reverse transcription polymerase chain reaction), while FISH (fl uorescent in situ hybridization) examination gave variable results -the fi rst apheresis was negative but all the following collections were positive in 5 % of cells.…”

Section: Case Reportmentioning

confidence: 99%

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

Skoumalova

Vondráková²,

Rosenberger³

et al. 2008

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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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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Two successful pregnancies in a chronic myeloid leukemia patient treated with imatinib

Cited by 31 publications

References 9 publications

Successful Pregnancy and Delivery in a Patient with Chronic Myeloid Leukemia while on Dasatinib Therapy

Successful Pregnancy and Delivery in a Patient with Chronic Myeloid Leukemia while on Dasatinib Therapy

How I treat leukemia during pregnancy

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

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