Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.
In Vivo. 2019 Sep-Oct;33(5):1593-1598. doi: 10.21873/invivo.11641.
BACKGROUND/AIM: As approximately 10% of individuals developing chronic myeloid leukemia (CML) are females aged 20-44 years, a considerable number will consider a planned pregnancy if disease is well controlled by pharmacological treatment. The management of these young patients during pregnancy represents a therapeutic dilemma due to the potential teratogen effects of several tyrosine kinase inhibitors (TKIs) and is a matter of continuous debate. Indeed, despite the existence of several studies, there is currently no consensus on how to manage different pregnancy situations in subjects with CML.
We describe a female patient diagnosed with Ph-positive CML one month after her first delivery who achieved excellent hematological, cytogenetic and molecular responses while on imatinib mesylate (IM) treatment.
The excellent responses allowed the patient to suspend TKI treatment in order to plan a second pregnancy. Despite IM discontinuation, stringent molecular monitoring of her BCR-ABL1/ABL1 levels allowed the safe delivery of the child and, while the patient eventually developed a molecular relapse after four years of treatment discontinuation, upon restarting IM she quickly regained a deep molecular response that is still ongoing.
Our case report demonstrates that, if the pregnancy is properly planned in CML patients, it can result in excellent management of the clinical therapeutic option for the benefit of both mother and child.
背景/目的：约有 10%的慢性髓性白血病（CML）患者为 20-44 岁的女性，如果疾病通过药物治疗得到很好的控制，相当一部分女性会考虑计划怀孕。由于几种酪氨酸激酶抑制剂（TKI）可能具有致畸作用，这些年轻患者在怀孕期间的管理是一个治疗难题，这也是一个持续争论的问题。事实上，尽管有几项研究，但目前对于 CML 患者不同妊娠情况的管理尚无共识。
我们描述了一名女性患者，她在第一次分娩后一个月被诊断出患有 Ph 阳性 CML，在接受甲磺酸伊马替尼（IM）治疗时取得了极好的血液学、细胞遗传学和分子反应。
极好的反应使患者能够暂停 TKI 治疗，以计划第二次怀孕。尽管停止了 IM 治疗，但对她的 BCR-ABL1/ABL1 水平进行严格的分子监测，使她能够安全分娩，尽管在停止治疗四年后患者最终出现了分子复发，但重新开始 IM 治疗后，她很快恢复了深度分子反应，目前仍在持续。
我们的病例报告表明，如果 CML 患者的妊娠得到适当计划，这可以为母婴双方带来益处，从而实现对临床治疗选择的极好管理。
