Discontinuation of Tyrosine Kinase Inhibitors and Pregnancy for Female Patients with Chronic Myeloid Leukemia - Abstract
More than 10 years has passed since the first BCR-ABL Tyrosine Kinase Inhibitor (TKI), iatinib, introduced into clinical practice in treatment for Chronic Myeloid Leukemia (CML). Addition to the development and clinical usage of more potent second generation TKIs, majority of patients with CP-CML can excellently control their disease and enjoy good quality of life. Recent prospective and retrospective discontinuation trials for imatinib suggested that roughly 40% of patients achieved Complete Molecular Response (CMR) for more than 2 years (or 24 months) would continue their CMR without relapse. Three female patients achieved long-term deep molecular response received
planned pregnant management involving careful molecular monitoring with or without interefone-? (IFN-?) during her pregnancy after stopping imatinib in our institute. Fortunately all patients delivered healthy babies, however, a patient with Sokal high risk at initially diagnosed lost her molecular, cytogenetic and hematologic response in spite of receiving IFN-?.
It would seem reasonable to recommend female patients who wish to become pregnant to wait until they have achieved CMR and sustained this for at least 2 years. Currently the proportion of patients obtaining prolonged and deep MR by treatment with imatinib is less than 10%, however, the use of second generation TKIs as first-line therapy will increase this percentage in near future. And continuing effort should be made to find optimal management for pregnant female patients with CP-CML.