Imatinib use during pregnancy and breast feeding: a case report and review of the literature

Ali, Rıdvan; Özkalemkaş, Fahir; Kímya, Yalçın; Köksal, Nilgün; Özkocaman, Vildan; Gulten, T; Yorulmaz, Hakan; Tunalı, Ahmet

doi:10.1007/s00404-008-0861-7

Cited by 74 publications

(41 citation statements)

References 31 publications

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“…Imatinib was found to be present at high concentration in the maternal blood and in the placenta; however, minimal or no drug was detected in the cord blood, suggesting that imatinib and its active metabolite cross the mature placenta poorly. A subsequent report by Ali et al [43] on imatinib exposure in pregnancy from the 21st to 39th week of gestation revealed that imatinib was present at 338 ng/mL in the cord blood and 478 ng/mL in the peripheral blood of the newborn compared to 1562 ng/mL in the maternal blood. There were no maternal-foetal complications observed in these cases.…”

Section: Treating CML In Pregnancymentioning

confidence: 93%

Managing pregnancy in chronic myeloid leukaemia

2015

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Over the past decade, we have witnessed significant advances in knowledge of the biology and treatment of chronic myeloid leukaemia (CML). The development of molecular-targeted therapy with tyrosine kinase inhibitors (TKIs) has fundamentally changed the outcome of this disease. Treatment with TKIs is now the standard of care in patients with CML and has dramatically improved long-term survival in the majority of patients. Patients who achieve major molecular response (MMR) after 2 years of treatment with imatinib have survival rates comparable to those of the general population. The success of TKIs has led to durable molecular response and possibility of normal life expectancies, such that it is now timely to address quality of life aspects such as fertility, pregnancy and family planning. Pregnancy in CML presents specific management and therapeutic challenges for the patient and the physician. Despite the recent treatment advances, we still have limited data on the safety of TKIs in pregnancy and its effect on fertility. However, there is a cause for concern and heightened awareness following the occurrence of a constellation of rare congenital malformations and spontaneous abortions in association with imatinib therapy. When a patient becomes pregnant whilst receiving TKI therapy, the difficulty lies in balancing the risk to the foetus of continuing therapy versus the risk to the patient of treatment interruption and potentially losing optimal disease response. All couples should be counselled on the risks associated with pregnancy whilst receiving TKI therapy. This is an essential aspect in patient care and frequently not emphasized enough by physicians. At the time of diagnosis, fertility preservation should be discussed with both male and female patients of childbearing potential. They should be made aware of fertility options which are available such as semen cryopreservation, ovarian or oocyte retrieval and storage and embryo cryopreservation in view of the potential detrimental effect of TKIs on fertility and gonadal function. The recommendation given to patients planning pregnancy differs according to their disease response to TKI therapy, which is the most important prognostic factor in CML.

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Section: Treating CML In Pregnancymentioning

confidence: 93%

Managing pregnancy in chronic myeloid leukaemia

2015

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“…week of gestation, and was present at 338ng/mL in the cord blood and 478 ng/mL in the peripheral blood infant (1/3 range) vs 1562 in maternal blood [48]. Summary of product characteristics recommend that all TKIs should not be used during pregnancy, in case of need, imatinib could be considered after the placenta is completely formed (12-14 weeks), and nilotinib even earlier, while dasatinib should never be used during all pregnancy.…”

Section: Diagnosed During Pregnancymentioning

confidence: 98%

Management of pregnant chronic myeloid leukemia patients

Abruzzese

Trawinska

Fabritiis

et al. 2016

Expert Review of Hematology

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Data published and informations acquired in terms of fertility, conception, pregnancy, pregnancy outcome and illness control for all the approved TKIs will be reviewed, as well as suggest how to manage a planned and/or unplanned pregnancy/conception. Literature search methodology included examination of PubMed index, meeting presentations, and updated Investigator's brochures and data files of TKIs companies. Expert commentary: Male patients trying to conceive apparently have no limitation in the use of TKIs, while effective contraception should be encouraged in all female patients due to the risk of fetal complications after drug exposure. In a female patient pregnancy should be planned and TKI therapy discontinued, while individual risks need to be considered when an unplanned pregnancy occurs.

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“…Some reports in literature indicate that patients who receive imatinib at the time of conception may have normal pregnancies. [67][68][69][70][71][72][73][74] Dasatinib and nilotinib are known to cause embryonic or fetal toxicities in animals. Isolated reports can be found in the literature regarding the outcome of pregnancy in patients receiving dasatinib [75][76][77] or nilotinib.…”

Section: Tki Therapy and Conceptionmentioning

confidence: 99%

Chronic Myelogenous Leukemia, Version 1.2015

O’Brien

Radich

Abboud

et al. 2014

J Natl Compr Canc Netw

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OverviewChronic myelogenous leukemia (CML) accounts for 15% of adult leukemias. The median age at disease onset is 67 years; however, SEER statistics show that CML occurs in all age groups. 1 In 2014, an estimated 5980 people will be diagnosed with CML in the United States, and 810 people will die from the disease. CML is characterized by the presence of Philadelphia chromosome (Ph) resulting from a reciprocal translocation between chromosomes 9 and 22 [t(9;22)]. This translocation, t(9;22), results in the head-to-tail fusion of the breakpoint cluster region (BCR) gene on chromosome 22 at band q11 and the Abelson murine leukemia (ABL1) gene located on chromosome 9 at band AbstractChronic myelogenous leukemia (CML) is usually diagnosed in the chronic phase. Untreated chronic phase CML will eventually progress to advanced phase (accelerated or blast phase) CML. Tyrosine kinase inhibitors (TKIs) have been shown to induce favorable response rates in patients with accelerated and blast phase CML. The addition of TKIs to chemotherapy has also been associated with improved outcomes in patients with blast phase CML. Allogeneic hematopoietic stem cell transplant remains a potentially curative option for patients with advanced phase CML, although treatment with a course of TKIs will be beneficial as a bridge to transplant. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with advanced phase CML. (J Natl Compr Canc Netw 2014;12:1590-1610 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. © National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Chronic Myelogenous Leukemia PanelAt the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.Individual disclosures for the NCCN Chronic Myelogenous Leukemia Panel members can be found on page 1610. (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)These guidelines are also available on the Internet. For the latest update, visit NCCN.org. q34. 3 The product of the BCR-ABL1 fusion gene, p210, which is a fusion protein with deregulated tyrosine kinase activity, plays a central role in the pathogenesis of CML. Another fusion protein, p190, is also produc...

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Imatinib use during pregnancy and breast feeding: a case report and review of the literature

Cited by 74 publications

References 31 publications

Managing pregnancy in chronic myeloid leukaemia

Managing pregnancy in chronic myeloid leukaemia

Management of pregnant chronic myeloid leukemia patients

Chronic Myelogenous Leukemia, Version 1.2015

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