Normal outcome of pregnancy in chronic myeloid leukemia treated with interferon‐α in 1<sup>st</sup>trimester: Report of 3 cases and review of the literature

Mubarak, Ahmed A.; Kakil, I. R.; Awidi, Abdalla; Al-Homsi, Ussama; Fawzi, Z. O.; Kelta, M; Al-Hassan, A

doi:10.1002/ajh.9876

Cited by 83 publications

(33 citation statements)

References 32 publications

(7 reference statements)

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“…However, IFN-α does not inhibit DNA synthesis [33]. Mutagenicity and teratogenicity have not been observed in animal studies of IFN-α [34]. Two major case reports on the safety of IFN-α in pregnancy [35,36] reported on the outcome of 40 patients (8 with CML, 27 with essential thrombocythaemia, 2 with hairy cell leukaemia, 1 with multiple myeloma and 2 carriers of hepatitis C) and their offspring.…”

Section: Treating CML In Pregnancymentioning

confidence: 96%

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: 96%

Managing pregnancy in chronic myeloid leukaemia

2015

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“…Leucostasis is a risk. Interferon alpha 10 or leukapheresis 11 treatment could be used but it is still a debatable issue as to when to initiate it. Finally, blast crisis is the most potentially fearful event.…”

Section: Two Successful Pregnancies In a Chronic Myeloid Leukemia Patmentioning

confidence: 99%

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

Garderet¹,

Santacruz²,

Barbu³

et al. 2007

Haematologica

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“…No adverse outcomes were found in the babies except for transient thrombocytopenia in one. 56 Alpha interferon is contraindicated in infants under 2 years of age because of severe neurotoxicity, 57,58 and thus a risk of fetal neurotoxicity may also exist. Whether these drugs impair fertility is not known.…”

Section: Issues Relating To Anti-viral Treatment For Chronic Hepatitimentioning

confidence: 99%

Maternal-infant transmission of hepatitis C virus infection

2002

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Mother-to-infant transmission of hepatitis C virus (HCV) is comparatively uncommon. The prevalence of antibody to HCV (anti-HCV) in pregnant women is 0.1% to 2.4%, although in some endemic areas it is much higher. The proportion of women with anti-HCV who have active infection with viremia is 60% to 70%. Transmission of HCV occurs only when serum HCV RNA is detectable and may be related to higher levels (above 10 6 copies per mL). M aternal and child health issues relating to hepatitis C virus (HCV) infection have recently assumed greater importance than ever before. From the pediatric perspective, the availability of effective screening methods for HCV has virtually eliminated new cases of transfusion-associated hepatitis C in children. Consequently, childhood acquisition of HCV infection through maternal-infant transmission has become the most important mode of spread. 1 Vertical, or more precisely, mother-to-infant hepatitis C will likely be the major type of childhood chronic hepatitis C within the next 6 to 8 years. It has been difficult to determine the rate of mother-to-infant transmission, partly because reports of mother-to-infant transmission of HCV have been based on small numbers of patients, with differing disease definitions, followed with different study designs and using different virological assays. These reports tended to be heterogeneous and conflicting. Moreover, factors that promote mother-to-infant transmission and the outcome of chronic HCV infection acquired by this route still require clarification. Likewise, for women of child-bearing age who acquired chronic hepatitis C in childhood or in early adulthood, there are important issues relating to pregnancy itself, such as its effect on the disease course of chronic hepatitis C. Prevalence of Hepatitis C Among Pregnant WomenNumerous studies have examined the prevalence of hepatitis C among pregnant women (Table 1). The studies vary considerably in terms of the size of the study, geographic variables, and adequacy of laboratory testing. In general, the prevalence of detectable antibody to HCV (anti-HCV) is approximately 1% overall (range, 0.1% to 2.4%), based on the studies that included at least 3,000 subjects. The mean Abbreviations: HCV, hepatitis C virus; anti-HCV, antibody to HCV; ALT, alanine aminotransferase; HIV, human immunodeficiency virus.

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Normal outcome of pregnancy in chronic myeloid leukemia treated with interferon‐α in 1^sttrimester: Report of 3 cases and review of the literature

Cited by 83 publications

References 32 publications

Managing pregnancy in chronic myeloid leukaemia

Managing pregnancy in chronic myeloid leukaemia

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

Maternal-infant transmission of hepatitis C virus infection

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Normal outcome of pregnancy in chronic myeloid leukemia treated with interferon‐α in 1sttrimester: Report of 3 cases and review of the literature

Cited by 83 publications

References 32 publications

Managing pregnancy in chronic myeloid leukaemia

Managing pregnancy in chronic myeloid leukaemia

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

Maternal-infant transmission of hepatitis C virus infection

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Normal outcome of pregnancy in chronic myeloid leukemia treated with interferon‐α in 1^sttrimester: Report of 3 cases and review of the literature