Managing women of childbearing age with chronic myeloid leukemia: safety and treatment considerations

ABSTRACT

Introduction

TKIs are paradigmatic in CML management and offer patients the prospect of a normal life expectancy. As a consequence, the focus of both the clinician and patient has shifted to considerations of quality of life, including the ability to parent children. Unfortunately, TKIs are teratogenic so that alternative treatment options may be required during pregnancy to adequately control disease and minimize risk.

Areas covered

In this review, we summarize and provide an overview of the literature on the management of CML in women of childbearing age. We discuss the various treatment options as well as their advantages, disadvantages, and safety considerations. We discuss CML in the context of: 1) planned pregnancies with CML; 2) unplanned pregnancies with CML; 3) CML diagnosed during pregnancy.

Expert opinion

Confidence in managing pregnancy and CML continues to grow. In the majority of cases, with careful planning and counseling, no treatment is required and disease control can be safely regained after pregnancy ends. For those who require treatment, various options are available and there is growing evidence to suggest that some TKIs may be safe in the later stages of pregnancy.

KEYWORDS:

• Chronic myeloid leukemia
• tyrosine kinase inhibitors
• pregnancy
• fertility
• interferon
• hydroxycarbamide

Article highlights

• To summarize the therapeutic agents used in CML as well as their safety and efficacy in pregnancy

• To provide a framework for clinicians to approach the planning of a pregnancy in a patient with CML

• To discuss the management considerations in CML diagnosed during pregnancy and unplanned pregnancies in those with CML

Declaration of interest

JF Apperley is an advisory board member for Incyte and Novartis and has received research funding from Incyte and Pfizer, and is in the speakers bureaus of Incyte and Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.