Chronic myeloid leukemia and pregnancy: patient and partner perspectives

Luskin, Marlise R.

doi:10.1080/17474086.2018.1500889

Cited by 8 publications

(5 citation statements)

References 15 publications

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“…Reports have recommended a collaborative approach between the patient and the hematology and obstetric teams regarding the management of pregnancy during TKI treatment for CML. Ideally, female patients with CML who wish to become pregnant should do so when in sustained molecular response and should stop therapy upon conception [ 7 , 9 , 10 , 18 , 19 ]. The effects of bosutinib on pregnancy experienced in the current study were largely similar to those reported for other TKIs, and female patients with CML should not be exposed to TKIs during pregnancy [ 5–11 , 20–23 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Patients Treated with Bosutinib

Cortés

Gambacorti‐Passerini

Deininger

et al. 2020

Int. J. Hematol. Oncol.

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Aim: Preclinical studies have shown reproductive toxicity with bosutinib, but little is known about its effects during conception or pregnancy in humans. Methods: Pregnancy cases in patients receiving bosutinib were identified from the Pfizer safety database. Results: Thirty-three pregnancy reports were identified. Sixteen cases of maternal exposure: six live births, four abortions and six with unknown outcomes. Seventeen instances of paternal exposure: nine live births, five abortions and three with unknown outcomes. Conclusion: Adverse effects of bosutinib exposure at conception or during pregnancy in humans cannot be excluded, particularly if therapy is not interrupted upon recognition of pregnancy. Contraceptive use is recommended for female patients receiving bosutinib, and patients should be made aware of the potential risks associated with bosutinib use during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes in Patients Treated with Bosutinib

Cortés

Gambacorti‐Passerini

Deininger

et al. 2020

Int. J. Hematol. Oncol.

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“…Since Pye et al first reported the outcomes of 180 female patients exposed to imatinib during pregnancy , more evidence has accumulated to indicate the potential embryotoxic and teratogenic effect of TKIs including imatinib , nilotinib , and dasatinib during pregnancy. Currently, for female patients with CML wishing to consider pregnancy, it is accepted that at least an MMR should be achieved prior to conception, and patients should remain off TKI during pregnancy, especially during the crucial first trimester . As to the specific degree and duration of the response that should be achieved before planned pregnancy, there is no consensus.…”

Section: Discussionmentioning

confidence: 99%

Planned Pregnancy in Female Patients with Chronic Myeloid Leukemia Receiving Tyrosine Kinase Inhibitor Therapy

et al. 2019

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Background The aim of this study was to explore outcomes of planned pregnancy in female patients with chronic myeloid leukemia (CML) on tyrosine kinase inhibitors (TKIs). Materials and Methods Data of female patients proceeding with a planned pregnancy were retrospectively reviewed. Results A total of 17 patients with CML who achieved at least a major molecular response (MMR) during imatinib (n = 13) or nilotinib (n = 4) therapy prior to a planned pregnancy were enrolled. At the time of TKI interruption, six were in MMR, two in molecular response 4 (MR4), and nine in molecular response 4.5 (MR4.5). TKI therapy was discontinued 6 weeks (range, 2–15 weeks) before conception in 4 patients and at gestational age of 4 weeks (range, 2–5 weeks) after determination of pregnancy in 13 patients. Apart from 1 patient who suffered a spontaneous abortion, 16 patients delivered uneventfully. A total of 10 patients lost MMR after stopping TKIs; 8 lost molecular response 2, and 3 lost complete hematological response. Log‐rank analyses showed achieving MR4 (p = .030) or MR4.5 (p = .031), complete cytogenetic response duration ≥3.5 years (p = .049), and MMR duration ≥3.5 years (p = .040) were significantly associated with longer MMR‐failure‐free survival during TKI interruption. Conclusion Planned pregnancy might be pragmatic in female patients with CML on TKIs. Achieving deep molecular response and, importantly, MMR duration ≥3.5 years were significantly associated with maintaining MMR during pregnancy. Implications for Practice Female patients with chronic myeloid leukemia on tyrosine kinase inhibitors (TKIs) wishing to conceive are currently advised to discontinue TKIs before conception. However, the ideal degree and duration of response before stopping TKI, in addition to whether there will be any adverse effect caused by a short exposure of TKI, is unknown. Data of 17 female patients, who achieved at least a major molecular response (MMR) before TKI interruption, was revised, and it was found that achieving deep molecular response and MMR duration ≥3.5 years was significantly associated with maintaining MMR during pregnancy. This provides direct evidence for a planned pregnancy strategy, and stopping TKI immediately after determination of pregnancy in female patients might be pragmatic.

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“…Leukapheresis was used in two patients with newly diagnosed CML and was well tolerated. This therapy is described as safe in this population, but should be performed in individual cases of hyperleukocytosis 17 …”

Section: Discussionmentioning

confidence: 99%

“…We observed in our series that the TKI interruption in patients with stable MMR did not affect the patient's outcome. A recent review reported that TKI discontinuation among patients who have achieved very deep and prolonged molecular remission is safe, and that TKIs may be reintroduced after delivery in case of a loss of MMR 17 …”

Section: Discussionmentioning

confidence: 99%

Management of chronic myeloid leukemia during pregnancy: a retrospective analysis at a single center

Moura

Delamain

Duarte

et al. 2019

Hematology, Transfusion and Cell Therapy

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We analyzed the management and outcomes of pregnancies of patients with chronic myeloid leukemia at a single center over fifteen years. Among the 203 CML female patients, there were ten pregnancies in seven women, all of them not planned. In three cases, the chronic myeloid leukemia diagnosis was made during pregnancy. Five patients received tyrosine kinase inhibitors in the first weeks of pregnancy and the drug was interrupted until delivery. One patient lost complete cytogenetic response, and two patients lost the hematological response. A patient with a stable major molecular response had two successful pregnancies without loss of response. There were four premature births. There were no maternal adverse events, fetal malformation or death. All patients received Interferon-alpha during gestation, and two received hydroxyurea for a short period. Leukapheresis was performed in two patients for hyperleukocytosis control. One patient with sickle cell disease died from disease progression six months after delivery. Conclusions The tyrosine kinase inhibitors ministration should be interrupted during pregnancy. Patients should be advised to achieve a stable and deep molecular response if they plan to conceive, to avoid the risk of disease progression.

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Chronic myeloid leukemia and pregnancy: patient and partner perspectives

Cited by 8 publications

References 15 publications

Pregnancy Outcomes in Patients Treated with Bosutinib

Pregnancy Outcomes in Patients Treated with Bosutinib

Planned Pregnancy in Female Patients with Chronic Myeloid Leukemia Receiving Tyrosine Kinase Inhibitor Therapy

Management of chronic myeloid leukemia during pregnancy: a retrospective analysis at a single center

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