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Pregnancy on 2nd generation TKI

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9 years 3 months ago #1044 by ppanayi
Replied by ppanayi on topic Pregnancy on 2nd generation TKI
The suggestion by Tim to storage of her fertilized eggs and use them after years(?) of 2ed gen TKI treatment is an excellent suggestion. It you'll be helpful to repeat the PCR ASAP to consolidate the rate of reappearance of CML. Concerning the IFN-a issue, I don't know if there is a consensus in the dose in CML pts' based on data in the IFN era. I have used 3Million U/day sc in a pregnancy with CML mainly due to lack of toxicity to the fetus ,with the hope of delaying CML reappearance.

Panos
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  • Beppe Saglio
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9 years 3 months ago #1045 by Beppe Saglio
Replied by Beppe Saglio on topic Pregnancy on 2nd generation TKI
Hi Tara. I agree with Tim, and I would not start imatinib until the loss of MMR. Around 25-30% of these initial increases in the amount of BCR-ABL are only transient and then They are followed by a return to MR4 or lower. In the meanwhile, she can continue to search to become pregnant and then, if she will lose MMR not pregnant she can restart imatinib (or nilotinib) whereas if she will lose MMR and then CCyR being pregnant she can start IFN.
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  • Franck Ncolini
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9 years 3 months ago #1046 by Franck Ncolini
Replied by Franck Ncolini on topic Pregnancy on 2nd generation TKI
In this case with this level of response, I usually use Peg-IFN alfa 2a (Pegasys Roche) 90 microg/week subcutaneously or IFn-alfa 2a (Roferon Roche) 3 millions units 3 times a week. Usually transcript raise to 1% and stabilize thereafter around this value. I ussually carry out interferon until the end of breastfeeding (if any) as TKi are excreted in maternal milk.
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  • jeff lipton
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9 years 3 months ago #1047 by jeff lipton
Replied by jeff lipton on topic Pregnancy on 2nd generation TKI
I agree with Franck, although the dose needs to be worked out. I would start her on Pegasys at 180mcg weekly and titrate the dose interval based on counts. If Pegasys is not available then use regualar IFN again titrating the dose and/or interval to keep the counts appropriate. Monitor the molecular level over the next 6-9 months and then if stable, she should try to get pregnant. There is some suggestion that eggs harvested while women are on imatinib may not be the best for IVF and early in vitro embryo death has been noted. Interferon is quite safe in pregnancy and I have had 2-3 patients on interferon undergone fertility therapy that resulted in successful pregnancy. This can include stimulation if necessary while on interferon. If the molecular response is lost during the 6-month observation period, then resume the TKI after harvesting eggs. I daresay the likelihood of this woman being able to stop TKI at a later date will be quite small if she could not stop and switch to interferon successfully at this stage.
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