Imperial College, Hammersmith Campus, London, England W12 0NN.
J Natl Compr Canc Netw. 2009 Nov;7(10):1050-8. doi: 10.6004/jnccn.2009.0069.
The introduction of tyrosine kinase inhibitors into clinical practice now offers most patients with chronic myelogenous leukemia lengthy remissions and the possibility of normal life expectancies. These improved survivals have resulted in the need to address issues relating to quality of life, including fertility and procreation. Treatment may require lifelong daily therapy with drugs that might inhibit proteins essential to gonadal function, implantation, and embryogenesis. Animal data suggest that imatinib at standard dosages is unlikely to impair fertility in either adult male or female animals. However, human data remain limited, particularly in children and adolescents. Children born to men who are actively taking imatinib at conception seem healthy, and current advice is not to discontinue treatment. In contrast, data are less encouraging for children born to women exposed to imatinib during pregnancy. Although numbers are small, a disturbing cluster of rare congenital malformations has prevented imatinib from being recommended safely, particularly during the period of organogenesis. Alternative strategies for managing pregnancy in chronic myelogenous leukemia include one or both of regular leukapheresis and interferon-alpha. Pregnancy in advanced-phase disease presents particular problems.
酪氨酸激酶抑制剂在临床实践中的引入，为大多数慢性髓性白血病患者提供了长期缓解和正常预期寿命的可能。这些生存的改善使得人们需要解决与生活质量相关的问题，包括生育和生殖。治疗可能需要终生每天用药物治疗，这些药物可能会抑制对性腺功能、着床和胚胎发生至关重要的蛋白质。动物数据表明，标准剂量的伊马替尼不太可能损害成年雄性或雌性动物的生育能力。然而，人类数据仍然有限，特别是在儿童和青少年中。在受孕时正在积极服用伊马替尼的男性所生的孩子似乎是健康的，目前的建议是不要停止治疗。相比之下，在怀孕期间接触伊马替尼的女性所生的孩子的数据则不那么令人鼓舞。尽管数量较少，但令人不安的一组罕见的先天性畸形使得伊马替尼无法安全使用，尤其是在器官发生期。管理慢性髓性白血病妊娠的替代策略包括定期白细胞去除和干扰素-α。晚期疾病的妊娠带来了特殊的问题。
