Expectations and outcomes of varying treatment strategies for CML presenting during pregnancy.

Autor: Robertson HF; Centre for Haematology, Imperial College London, London, UK.; Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK., Milojkovic D; Centre for Haematology, Imperial College London, London, UK.; Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK., Butt N; Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK., Byrne J; Nottingham University Hospital NHS Trust, Nottingham, UK., Claudiani S; Centre for Haematology, Imperial College London, London, UK.; Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK., Copland M; Paul O'Gorman Leukaemia Research Centre, School of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK., Gallipoli P; Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK., Innes AJ; Centre for Haematology, Imperial College London, London, UK.; Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK., Knight K; Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, UK., Mahdi AJ; Department of Haematology, Aneurin Bevan University Health Board, Newport, UK., Parker J; Northampton General Hospital, Northampton, UK., Virchis A; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK., Apperley JF; Centre for Haematology, Imperial College London, London, UK.; Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Jazyk: angličtina
Zdroj: British journal of haematology [Br J Haematol] 2024 Sep; Vol. 205 (3), pp. 947-955. Date of Electronic Publication: 2024 May 02.
DOI: 10.1111/bjh.19491
Abstrakt: Diagnosing chronic myeloid leukaemia (CML) during pregnancy is rare. Tyrosine kinase inhibitors (TKIs) have traditionally been contraindicated owing to their teratogenicity. Management decisions should consider the risks to mother and foetus of uncontrolled disease and teratogenic medications. Further cases are required to build upon the paucity of current literature. We report 22 cases of CML diagnosed during pregnancy from 2002 to date. Twenty-one pregnancies resulted in healthy babies and one patient miscarried. Some patients remained untreated throughout pregnancy but the majority received one or both of interferon-α and leucapheresis. One patient was started on imatinib at Week 26, and one on hydroxycarbamide in the third trimester. We report haematological parameters during pregnancy to provide clinicians with realistic expectations of management. There were no fetal abnormalities related to treatment during pregnancy. Seventeen patients achieved at least major molecular response on first-line TKI. A diagnosis of CML during pregnancy can be managed without significant consequences for mother or child. Leucapheresis and interferon-α are generally safe throughout pregnancy. Despite having been avoided previously, there is growing evidence that certain TKIs may be used in particular circumstances during the later stages of pregnancy. Future work should aim to further elucidate this safety profile.
(© 2024 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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