Management of chronic myeloid leukemia (CML) in pregnant women: a comprehensive literature review

Abstract

Background and Objective: The occurrence of chronic myeloid leukemia (CML) during pregnancy poses a complex presentation, encompassing risks to both the maternal host and the developing fetus, resulting from the disease process and its therapeutic interventions. The management of this dual concern entails a contentious approach, compounded by inconclusive outcomes from preceding studies. The aim of this review is to synthesize a robust framework for an optimal approach to addressing CML in the context of pregnancy. Methods: In this comprehensive literature review, we systematically examined peer-reviewed articles published in reputable academic journals. Key Contents and Findings: Pregnancy in patients diagnosed with CML can proceed if the CML is in the chronic phase and on the way to achieving major molecular response (MMR). Treatment risks, CML progression, and complication should be discussed, with treatment becoming necessary when risks become significant. Leukapheresis is limited in reducing white blood cell count temporarily. Interferon (IFN) is the safest option during the first trimester. Previous studies advised against tyrosine kinase inhibitor (TKI) use before 15 weeks, but recent research suggests potential use after organogenesis with careful risk-benefit analysis. Dasatinib isn’t recommended during pregnancy due to limited safety data. Decision-making varies based on treatment response and risks, with discontinuation leading to potential complications and continuing treatment leading to some fetal malformations. TKI discontinuation remains recommended if MMR achieved. The decision to stop TKI treatment involves continuous monitoring factors like relapse and recurrence. Conclusions: While potent treatments like TKIs are essential, their adverse effects complicate their use in pregnant individuals. The use of TKIs and other possible treatments of CML during pregnancy has its own accepted indications and limitations. This review of literature aids hematologic oncologists in managing CML during pregnancy.