Managing Pregnancy in Patients With CML

Elisabetta Abruzzese, MD of S. Eugenio Hospital, discusses the management of pregnancy in patient with chronic myeloid leukemia (CML).

According to Abruzzese, the management of pregnancy in CML has changed drastically over the past 10 years. There are 2 cases that clinicians should be aware of, when a patient is pregnant and discover CML and the other when a patient has CML and gets pregnant during treatment.

Tyrosine kinase inhibitors (TKIs) should been stopped at the first positive pregnancy test, as they are teratogenic, according to Arbuzzese. This means that the development of fetal organs can be impacted. There use is especially dangerous during the fifth through the tenth week of gestation. TKIs should be stopped around the fourth week of gestation.

0:08 | The management of pregnancy in CML has changed a lot in the past 10 years. We now have some recommendations that can help clinicians get through this. We basically distinguish among the 2 main topics, which are patients that get pregnant and discover CML while they are pregnant and patients with CML already treated for CML, who get pregnant during treatment. Depending on what kind of situation a physician has, there are different approaches they can take.

1:00 |Generally, TKIs that are the main drug that can be used in in CML patients must be stopped at first pregnancy tests because they can be toxic and are teratogenic. This means that they can impact on the on the organs and fetal development, especially during the first week of pregnancy. The teratogenesis is the most dangerous during the fifth until the tenth week of gestation. This means that a TKI can be used until the first pregnancy test turn positive around the fourth week of gestation and must be stopped around the fifth and the sixth week that are the most dangerous. But 2 of those drugs mainly, imatinib [Gleevec] and nilotinib (Tasigna) pass poorly in the placenta and this means that after the 16th week of gestation when organogenesis has ended, and placenta is formed, if necessary, they can be used again to prevent progression of the CML.