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CML and Pregnancy

  • pmartiat@ulb.ac.be
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13 years 2 months ago #32 by pmartiat@ulb.ac.be
Replied by pmartiat@ulb.ac.be on topic Re:CML and Pregnancy
I fully agree with Tim, John and Giuseppe. The question is after she achieves the best possible response within 3 to 6 months, she should normally stop the TKI for a couple of months, then if everything works well, for nine months. It looks unlikely that she achieves a CCyR or a MMR after 3 months. And we know from the study performed by FX Mahon that even in patients in CMR for 2 years or more, that at least 50% will relapse within 6 months after discontinuation of TKI. So, I would be interested to know what you think about IFN maintenance.

Philippe Martiat
  • Franck Nicolini
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13 years 2 months ago #33 by Franck Nicolini
Replied by Franck Nicolini on topic Re:CML and Pregnancy
I would personnally encourage, as Tim and John said, right away a second generation TKI in order to get the best response we can (at least MMR or CMR)after a year or so and start Peg IFNa2a and allow pregnancy after one month of this treatment (TKI2 washout will be complete). There are some anecdotical reports of pregnancies on PegIFN2a for hepatitis B & C patients, with safe issues. I had some experiences of pregnancies in CML and JAK2 negative ET patients on PEgIFN 2a. In CML the molecular response (MMR) was maintained with 90 microg/week, and it was well tolerated. The course of the pregnancy was normal and the delivery as well. TKI (Imatinib) in this case was restarted soon after birth with no breast-feeding. Although this is only a case report, this needs to be confirmed on larger series of patients, and some recommandations might be written somewhere. However, we do not need to throw native IFNalfa 2a or 2b away too !
Best wishes for 2011 to all
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13 years 2 months ago #51 by arnuparp.l
Replied by arnuparp.l on topic Re:CML and Pregnancy
I have another different case of CML with pregnancy. Your opinion and suggestion are welcomed. She was 26 year old with a newly diagnosed asymptomatic CML. She was accidentally diagnosed because of missed period and routine CBC for ANC. Spleen was 5 cm palpable and the WBC count was about 120K. Sokal score was 0.64 (low-risk). She now carries about 18-10 week of gestation and she wants this baby. She is not able to financially support for IFN. What are your opinions?
Should I wait until she deliver her baby? Or, when should I start imatinib? What gestational age should imatinib be safe for organogenesis? Thank you.
  • Pankaj Malhotra
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13 years 1 month ago - 11 years 8 months ago #56 by Pankaj Malhotra
Replied by Pankaj Malhotra on topic Re:CML and Pregnancy
After the first trimester is over, it may be justifiable to start the patient on Imatinib in standard dose. At least one paper does suggest that active metabolite of Imatinib does not cross the placenta (Russell MA et al. Imatinib mesylate and metabolite concentrations in maternal blood, umbilical cord blood, placenta and breast milk. Journal of Perinatology 2007; 27: 241–243.)

There are anecdotal reports of use of Hydroxyurea without its adverse affects on baby.

The last option may be to do leukapharesis at regular interval.

The most important thing in my mind is to discuss the pros and cons of each option involving the patient (and her husband) in decision making process.
Last edit: 11 years 8 months ago by Jan.
Moderators: Nicolaarlene