SUCCESSFUL MANAGEMENT OF CML DURING PREGNANCY AND IN POST-PARTUM PERIOD

Background:

The occurrence of any leukemia during pregnancy is rare, with an estimated incidence of 1:100,000 pregnancies annually. Chronic myeloid leukemia (CML) covers less than 10% of leukemias during pregnancy. The median onset age of CML is in the sixth decade, however about 10-15% of cases occur in women in childbearing age. Possibility of pregnancy is therefore a current topic. The CML therapy during pregnancy is limited by teratogenic side effect risk. Except some case reports Pye at al. (2008) reported relevant cohort of these patients. Data on human fetal development in pregnant women and patient partners with CML are still limited, which led us to report data of our centre.

Aims:

To verify a possibility of effective CML treatment during running pregnancy without fetal development hazard together with achievement of optimal response after delivery.

Methods:

Between the years 2000-2012 we determined 12 pregnancies in 11 patients with CML and 9 pregnancies in 8 patients´ partners.

Four patients decided for artificial abortion. Remaining 8 pregnancies in 7 patients continued to delivery. Except one patient who recognized the pregnancy in 20^th week, all the others were found out in the first trimester. Five pregnancies were confirmed in parallel with CML diagnoses without pretreatment. One patient was pretreated with imatinib (IM) for 18 months, one with interferon (IFN) for 24 months. One patient after successful delivery, who achieved major molecular remission (MMoR) on dasatinib (DA), discontinued treatment because of planning the second pregnancy.

In the first trimester, patients were either untreated or leukodepleted, in the second and third trimester they were treated with lekapheresis and/or interferon, or were without treatment. Seven male patients were treated with imatinib and one with dasatinib median 18 months (range 8-101) before conception. One patient became twice father during tyrosine kinase inhibitors consumption.

Results: All these 8 pregnancies (in 7 women) terminated with birth of healthy infants carried to term (4 girls and 4 boys). Current age of children is 1 month to 12 years.

In 5 patients after the delivery IM treatment was initiated, in 4 of them followed with DA, one patient continued on IFN treatment. In all 6 patients complete cytogenetic response was achieved (median 18 months), in 5 subsequently MMoR as well. One patient has not been evaluated yet due to short time of treatment.

One patient was treated with dasatinib with lasting MMoR prior pregnancy. At her request to have a baby (second child during CML therapy), the treatment was interrupted before conception. Although she lost MMoR, she did not need any treatment during pregnancy and she gave birth to healthy child. In 3 months after dasatinib return MMoR was restored.

Pregnancies of CML patients´ partners were without complication terminated with birth of healthy children, only one child required surgical resolution of umbilical hernia.

All women have good quality of life 8 to 172 months from CML diagnosis and 1 to 111 months from delivery.

Summary / Conclusion:

All female patients who had decided to keep going their pregnancies gave birth to healthy children and subsequently achieved very good treatment response. The treatment of CML during pregnancy did not jeopardize fetal development and did not negatively influence long lasting results. Also pregnancies of CML patients´ partners seem to be mostly without any complications. However the treatment of pregnant CML patients requires close cooperation between experienced hematologist and obstetrician.

Supported by IGA NT13899.

Email address: hana.klamova@uhkt.cz

 Keywords: Chronic myeloid leukemia, Pregnancy, Treatment

Abstrakta v časopise Haematologica 2013, Suppl1

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