Centre for Haematology, Imperial College London, London, UK.
Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Br J Haematol. 2024 Sep;205(3):947-955. doi: 10.1111/bjh.19491. Epub 2024 May 2.
Diagnosing chronic myeloid leukaemia (CML) during pregnancy is rare. Tyrosine kinase inhibitors (TKIs) have traditionally been contraindicated owing to their teratogenicity. Management decisions should consider the risks to mother and foetus of uncontrolled disease and teratogenic medications. Further cases are required to build upon the paucity of current literature. We report 22 cases of CML diagnosed during pregnancy from 2002 to date. Twenty-one pregnancies resulted in healthy babies and one patient miscarried. Some patients remained untreated throughout pregnancy but the majority received one or both of interferon-α and leucapheresis. One patient was started on imatinib at Week 26, and one on hydroxycarbamide in the third trimester. We report haematological parameters during pregnancy to provide clinicians with realistic expectations of management. There were no fetal abnormalities related to treatment during pregnancy. Seventeen patients achieved at least major molecular response on first-line TKI. A diagnosis of CML during pregnancy can be managed without significant consequences for mother or child. Leucapheresis and interferon-α are generally safe throughout pregnancy. Despite having been avoided previously, there is growing evidence that certain TKIs may be used in particular circumstances during the later stages of pregnancy. Future work should aim to further elucidate this safety profile.
在怀孕期间诊断慢性髓性白血病（CML）较为罕见。由于酪氨酸激酶抑制剂（TKI）具有致畸性，传统上被认为是禁忌。管理决策应考虑疾病未得到控制和致畸药物对母亲和胎儿的风险。需要进一步的病例来建立在当前文献的缺乏基础上。我们报告了 2002 年至今怀孕期间诊断出的 22 例 CML。21 例妊娠导致健康婴儿，1 例患者流产。一些患者在整个怀孕期间未接受治疗，但大多数患者接受了干扰素-α和白细胞分离术的一种或两种治疗。一名患者在第 26 周开始使用伊马替尼，一名患者在孕晚期开始使用羟基脲。我们报告了怀孕期间的血液学参数，为临床医生提供了对治疗管理的现实期望。怀孕期间治疗与胎儿异常无关。17 名患者在一线 TKI 治疗中至少达到了主要分子缓解。怀孕期间诊断出 CML 可以在不对母亲或孩子造成重大影响的情况下进行管理。白细胞分离术和干扰素-α在整个怀孕期间通常是安全的。尽管之前避免使用，但越来越多的证据表明，某些 TKI 在妊娠后期的某些情况下可能会被使用。未来的工作应该旨在进一步阐明这种安全性。
