Abstract
The occurrence of chronic myeloid leukemia in pregnancy is rare and its management poses a clinical challenge for physicians treating these patients. We report a 30-year-old woman with chronic myeloid leukemia who became pregnant twice successfully. Philadelphia-positive CML in its chronic phase was diagnosed at 16 weeks of her first gestation. At that time, she received no treatment throughout her pregnancy. At 38 weeks of gestation, a normal infant was delivered by cesarean section. At six weeks postpartum, the patient underwent imatinib mesylate therapy but she could not tolerate the treatment. The treatment was then changed to nilotinib at 400 mg orally b.i.d. Two years later, she became pregnant again while she was on nilotinib 200 mg b.i.d. The unplanned pregnancy was identified during her 7.4 weeks of gestation. Because the patient elected to continue her pregnancy, nilotinib was stopped immediately, and no further treatment was given until delivery. Neither obstetrical complications nor structural malformations in neonates in both pregnancies were observed. Both babies' growth and development have been normal. Although this experience is limited to a single patient, the success of this patient demonstrates that the management of chronic myeloid leukemia in pregnant women may be individualized based on the relative risks and benefits of the patient and fetus.
Highlights
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder that occurs as a result of a reciprocal translocation between chromosome 22 and chromosome 9, or the Philadelphia translocation [1]
The inability of patients to tolerate treatment and the emergence of bcr-abl mutations that reduced the binding affinity of imatinib prompted pharmaceutical research that led to the discovery of effective, targeted, second generation TK inhibitor (TKI) such as nilotinib (Novartis) and dasatinib (Bristol-Myers Squibb)
Case description In February 2006, during a routine antenatal examination, a 30-year-old woman at 16 weeks of gestation was diagnosed with Philadelphia-positive CML in its chronic phase
Summary
Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder that occurs as a result of a reciprocal translocation between chromosome 22 and chromosome 9, or the Philadelphia translocation [1]. In February 2006, during a routine antenatal examination, a 30-year-old woman at 16 weeks of gestation was diagnosed with Philadelphia-positive CML in its chronic phase. She was normal upon physical examination without any noteworthy clinical symptoms. In the 4 weeks after imatinib was stopped, hepatotoxicity was reduced to grade 1 Another attempt at low dose imatinib (300 mg daily) was again followed by elevations in hepatic enzymes. In August 2008, she was in complete cytogenetic remission and major molecular response At that time, she became pregnant while she was on nilotinib 200 mg b.i.d. The unplanned pregnancy was identified during her first trimester of gestation after the patient had experienced 7.4 weeks of amenorrhea.
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