Chronic myeloid leukemia with pregnancy: Successful management of pregnancy and delivery with hydroxyurea and imatinib continued till delivery

Yadav, Usha; Solanki, Sohan Lal; Yadav, Rupesh

doi:10.4103/0973-1482.119305

Cited by 19 publications

(9 citation statements)

References 8 publications

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“…Data of pregnancy during exposure to other TKIs is much more limited [35]. In contrast, there are also several case reports where babies exposed to TKIs throughout the pregnancy have been born with no detectable abnormalities [36,37,38]. However, these instances represent mere anecdotes and cannot be considered as evidence of the safety of this approach.…”

Section: Pregnancy and CMLmentioning

confidence: 99%

Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature

Pemmaraju

Cortés

2014

Acta Haematol

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Over the past two decades, many improvements have been made in the management of patients with leukemia. Research in this field most often focuses on the youngest and oldest patient age groups. However, the population of patients in between those age groups has received relatively little attention with few studies specifically focusing on them. This important ‘age gap' has demonstrated a unique, difficult-to-treat group of patients known as adolescents and young adults, or AYAs. Variably defined in the literature as patients from late teenage years to the age of up to 40 years, the AYA group of patients represents a vulnerable subset of patients now identified to require its own focus, development of therapeutic strategies and parallel emphasis on special support systems involving multidisciplinary psychosocial care. Despite the great advancements that have been realized for patients with chronic myeloid leukemia (CML), the AYA group has seldom been the focus of specific reports and studies, and the outcome appears to lag behind the general population. This review focuses on this subset of AYA patients with CML and summarizes the available data and recent developments, challenges and treatment options for this group of patients.

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Section: Pregnancy and CMLmentioning

confidence: 99%

Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature

Pemmaraju

Cortés

2014

Acta Haematol

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“…The role of TKI in pregnancy has been riddled with controversies due to potential fetal malformations [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Imatinib, a newer category D drug is a tyrosine kinase inhibitor (TKI) which can prolong CP of CML thereby improving the quality of life, short of curative option of stem cell transplantation. TKI in pregnancy have shown fetal abnormalities recently despite contradicting anecdotal reports of favourable outcomes in the past [6][7][8]. Though there is enough information on the use of TKI in pregnant females with CML, surprisingly there is little information on the effects of CML per se on the pregnancy and on the complications encountered both in baby/mother secondary to CML.…”

Section: Introductionmentioning

confidence: 99%

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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“…Others recommend TKI discontinuation throughout the first trimester. Various other therapies including hydroxyurea, interferon, various combinations of chemotherapeutic agents, and intensive leukapheresis have been suggested to lower the risk of progression, induce rapid disease control, or possibly reverse the blastic stage for those who are unable or unwilling to continue with TKI therapy, but these have not been validated [ 16 , 17 ].…”

Section: Commentsmentioning

confidence: 99%

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

Rebahi

Sliman

Adib

2018

Case Reports in Obstetrics and Gynecology

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Background Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm related to chromosomal reciprocal translocation t(9;22). Tyrosine kinase inhibitors (TKIs) such as imatinib have drastically revolutionized the course and the prognosis of this hematologic malignancy. As we know, the association pregnancy-CML is an infrequent situation. Also the use of TKI in pregnant women is unsafe with a lack of alternatives and effective therapeutic options. Thus its cessation during gestation puts those patients at high risk of developing blast crisis characterized by poor outcomes. Case Report A 37-year-old pregnant woman, gravida 2, para 2, with a previous cesarean section in 2011, presented to the obstetric unit. Her medical past revealed that she is a newly diagnosed patient with CML managed by TKI during her preconception period. Due to the perilous use of TKI during her pregnancy, a switch to interferon-α administration was adopted. But after the completion of 36 weeks of gestation, disease progression (relapse with blast crisis), attested by biological worsening, a white blood cell count = 245000/mm3 with 32% blasts in the peripheral blood, urged the medical team to opt for cesarean delivery. She underwent general endotracheal anesthesia without any perioperative incidents and gave birth to a healthy newborn. Ten days later, the patient was started on TKI. Discussion Although data on this specific and challenging situation are limited, this case highlights the difficulties encountered by the anesthesiologists when choosing the accurate anesthetic strategy and how important it is to weigh the risks and benefits inherent to each technique. Above all, taking into consideration the possible central nervous system (CNS) contamination by circulating blast cells when performing spinal or epidural approach is primordial. This potential adverse event (CNS blast crisis) is extremely scarce but it is responsible for high rates of morbidity and mortality.

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Chronic myeloid leukemia with pregnancy: Successful management of pregnancy and delivery with hydroxyurea and imatinib continued till delivery

Cited by 19 publications

References 8 publications

Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature

Chronic Myeloid Leukemia in Adolescents and Young Adults: Patient Characteristics, Outcomes and Review of the Literature

Obstetric Complications and Management in Chronic Myeloid Leukemia

Chronic Myeloid Leukemia and Cesarean Section: The Anesthesiologist’s Point of View

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