Department of Haematology, Imperial College, Hammersmith Hospital, Ducane Road, London W120NN, UK.
Best Pract Res Clin Haematol. 2009 Sep;22(3):455-74. doi: 10.1016/j.beha.2009.09.008.
With the improved survivals offered by the tyrosine kinase inhibitors has come the necessity to address issues relating to quality of life and one such area is that of fertility and parenting. Animal data suggest that imatinib at standard dosages is unlikely to impair fertility in either adult males or females but human data remain limited. Children born to men who are actively taking imatinib at the time of conception appear healthy and current advice is not to discontinue treatment. In contrast the data relating to children born to women exposed to imatinib during pregnancy are less encouraging. Although numbers are small there has been a disturbing cluster of rare congenital malformations such that imatinib cannot be safely recommended, particularly during the period of organogenesis. The appropriate management of children with CML has also been radically changed by the advent of imatinib. The features of the disease at presentation, the natural history and the response to therapy seem to be identical in children to that seen in adults. Now that imatinib has been in clinical use for almost ten years without severe long-term side effects, most physicians are now comfortable advising a trial of imatinib prior to consideration of transplant. Data relating to the efficacy and safety of second generation tyrosine kinase inhibitors in childhood is entirely absent and transplant remains the first choice for patients failing imatinib and perhaps also for young patients with sub-optimal responses.
随着酪氨酸激酶抑制剂带来的生存改善，必须解决与生活质量相关的问题，其中一个领域是生育和育儿。动物数据表明，标准剂量的伊马替尼不太可能损害成年男性或女性的生育能力，但人类数据仍然有限。在受孕时正在积极服用伊马替尼的男性所生的孩子看起来很健康，目前的建议是不要停止治疗。相比之下，关于怀孕期间暴露于伊马替尼的女性所生的孩子的数据则不太令人鼓舞。尽管数量很少，但已经出现了一系列令人不安的罕见先天性畸形，因此不能安全推荐伊马替尼，尤其是在器官发生期。伊马替尼的出现也彻底改变了儿童慢性髓系白血病的治疗管理。目前，儿童的疾病表现、自然病史和对治疗的反应与成人所见完全相同。现在，伊马替尼已经在临床上使用了将近十年，没有严重的长期副作用，大多数医生现在都愿意在考虑移植之前，建议尝试使用伊马替尼。关于第二代酪氨酸激酶抑制剂在儿童中的疗效和安全性的数据完全缺失，移植仍然是对伊马替尼治疗失败的患者以及对反应不佳的年轻患者的首选。
