Revista de genética y genomas.

Successful Management of Three Pregnancies Under Imatinib Treatment in a Chronic Myeloid Leukemia Patient: A Case Report and Review of the Literature

Abstract

Abdulsamad Wafa, Suher AL-Medani, Thomas Liehr, Faten Moassass, Walid AL-Achkar

Background:Imatinib Mesylate (IM), the first tyrosine kinase inhibitor recommended for the treatment of Chronic Myeloid Leukemia (CML) patients with presence of Philadelphia chromosome (Ph), led to marked improvement in the survival of patients in all phases of disease. The incidence of CML associated with pregnancy is not that rare, however, patients normally avoid exposure to IM treatment during the pregnancy due to potential teratogenic effects possibly leading to malformation in the fetus and also secondarily providing a risk for the patient’s life.
Case report: We report three successful pregnancies with deliveries of healthy offspring in one female diagnosed with CML. She was treated with IM (400 mg/day) as a first-line therapy and lost complete hematologic response twenty-two months after IM treatment started. At this point she planned a pregnancy, despite her doctor’s concerns. Due to non–-availability of drugs and the political situation in her home country the patient could not take IM regularly, leading to a Ph-positiveness since 2009. Still, during this period the patient successfully delivered three normal babies without any regular medical control for IM treatment. Thus, the patient and her fetuses were exposed to various doses of IM (400, 600 and 800 mg per day), in parts throughout first trimester and during lactating.
Results:The use of IM did not have any adverse effects on any of the three fetuses, except for potential positive influence on birth weight in the first child she delivered.
Conclusion:Pregnancy is an important part of life in young cancer patients. If possible, it is paramount to counsel pregnant patients to switch to drugs without adverse effects on the developing fetus. However, as highlighted by the present case, pregnancies exposed to tyrosine kinase inhibitors such as IM do not necessarily lead to adverse outcomes.