Management of pregnant chronic myeloid leukemia patients

ABSTRACT

Introduction: Since the introduction of tyrosine kinase inhibitors (TKIs) therapy, chronic myeloid leukemia (CML), has moved from a fatal illness to a manageable disease with a possible normal lifespan.

For this reason is more and more frequent that younger patients address the possibility to conceive, if men, or get pregnant, if women.

Knowledge of safety and risks concerning both patient and progeny, as well as important cultural, ethical and psychosocial issues must be taken into consideration.

Areas covered: Data published and informations acquired in terms of fertility, conception, pregnancy, pregnancy outcome and illness control for all the approved TKIs will be reviewed, as well as suggest how to manage a planned and/or unplanned pregnancy/conception. Literature search methodology included examination of PubMed index, meeting presentations, and updated Investigator’s brochures and data files of TKIs companies.

Expert commentary: Male patients trying to conceive apparently have no limitation in the use of TKIs, while effective contraception should be encouraged in all female patients due to the risk of fetal complications after drug exposure. In a female patient pregnancy should be planned and TKI therapy discontinued, while individual risks need to be considered when an unplanned pregnancy occurs.

KEYWORDS:

• Chronic myeloid leukemia
• conception
• TKIs
• imatinib
• dasatinib
• nilotinib
• bosutinib
• ponatinib
• pregnancy

Acknowledgments

This work is dedicated to all patients who live their life with CML and to all their babies that are born and will born in the years to come.

Declaration of interest

M Baccarani is a consultant and speaker for Ariad, BMS, Novartis and Pfizer. E Abruzzese is a consultant for Ariad, BMS, Novartis and Pfizer. 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.

Additional information

Funding

This paper was not funded.