[慢性髓性白血病患者的生育力与疾病结局]
[Fertility and disease outcomes in patients with chronic myeloid leukemia].
作者信息
Dou X L, Qin Y Z, Shi H X, Lai Y Y, Hou Y, Huang X J, Jiang Q
机构信息
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Rearch Center for Hematologic Disease, Beijing 100044, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2019 Dec 14;40(12):980-985. doi: 10.3760/cma.j.issn.0253-2727.2019.12.002.
To explore Fertility and disease outcomes in patients with chronic myeloid leukemia (CML) . Clinical and fertility outcomes of male (from Jul. 1998 to Feb. 2018) and female CML (from Sep. 2009 to Feb. 2018) patients were retrospectively analyzed at Peking University People's Hospital. A total of 49 male CML patients and their spouses were enrolled. Before their spouses conceived, 34 patients were receiving tyrosine kinase inhibitor (TKI) imatinib, 9 with nilotinib, and 6 with dasatinib. At the time of conception, the median age of these male patients was 32 years (range, 25-48 years) , and the median TKI treatment duration was 36 months (range, 0.2-198 months) . One male patient having achieved complete hematologic response yet discontinuing TKI for a year developed a disease progression to blast crisis. The other 48 patients sustained stable disease. The total conception times were 61 and finally 55 infants were born including one with premature birth, two with low birth weight, and one with hypospadias receiving surgery. The other 18 female patients after pregnancy were enrolled. Two patients developed spontaneous abortions. Two received induced abortions. Fourteen gave birth to healthy infants without congenital malformation. The interval from diagnosis of CML to initiation of TKI was 4 months (range, 0.3-16 months) . During a median follow-up of 45 months (range from 7-114 months) , the estimated complete cytogenetic response (CCyR) rate, major molecular response (MMR) rate and molecular response(4.5) (MR(4.5)) rate by 5 years were 88.9%, 85.3% and 35.1%, respectively. The estimated failure-free survival, progression-free survival and overall survival were 64.2%, 90.9% and 90.9%, respectively. All 14 babies developed as normal. It seems that TKIs do not affect pregnancy outcome in the spouses of male CML patients, suggesting that withdrawal of TKIs is not necessary. Female CML patients have good pregnancy and disease outcomes in the TKI era.
探索慢性髓性白血病（CML）患者的生育情况和疾病转归。北京大学人民医院对男性（1998年7月至2018年2月）和女性CML患者（2009年9月至2018年2月）的临床和生育结局进行了回顾性分析。共纳入49例男性CML患者及其配偶。在其配偶受孕前，34例患者接受酪氨酸激酶抑制剂（TKI）伊马替尼治疗，9例接受尼罗替尼治疗，6例接受达沙替尼治疗。受孕时，这些男性患者的中位年龄为32岁（范围25 - 48岁），TKI治疗的中位持续时间为36个月（范围0.2 - 198个月）。1例已达到完全血液学缓解但停用TKI一年的男性患者疾病进展至急变期。其他48例患者病情稳定。总受孕次数为61次，最终出生55名婴儿，其中1例早产、2例低体重、1例尿道下裂接受了手术。另外18例怀孕后的女性患者也被纳入。2例患者发生自然流产。2例接受人工流产。14例分娩出健康婴儿，无先天性畸形。从CML诊断到开始使用TKI的间隔时间为4个月（范围0.3 - 16个月）。在中位随访45个月（范围7 - 114个月）期间，5年时估计的完全细胞遗传学缓解（CCyR）率、主要分子学缓解（MMR）率和分子学缓解（4.5）（MR(4.5)）率分别为88.9%、85.3%和35.1%。估计的无失败生存率、无进展生存率和总生存率分别为64.2%、90.9%和90.9%。所有14名婴儿发育正常。似乎TKI对男性CML患者配偶的妊娠结局没有影响，这表明无需停用TKI。在TKI时代，女性CML患者有良好的妊娠和疾病结局。
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