Kondo Takeshi, Matsuki Eri, Takaku Tomoiku, Watanabe Naoki, Yoshida Chikashi, Okada Masaya, Murai Kazunori, Kodama Takashi, Takahashi Naoto, Kimura Shinya, Matsumura Itaru
Blood Disorders Center, Aiiku Hospital, Sapporo, Hokkaido, Japan.
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Cancer. 2025 Jan 1;131(1):e35611. doi: 10.1002/cncr.35611. Epub 2024 Oct 30.
Young female patients with chronic myeloid leukemia (CML) often face challenges becoming pregnant due to the teratogenicity of tyrosine kinase inhibitors (TKIs).
The authors conducted a nationwide survey of female patients with CML who experienced pregnancy between 2002 and 2020.
Information for 70 pregnancies in 49 patients was obtained. There were three types of pregnancies: CML onset during pregnancy (n = 9), unplanned pregnancy mostly during treatment with a TKI (n = 25), and planned pregnancy during treatment-free remission (TFR) or treatment with interferon-alpha (IFN-α) (n = 36). The median duration from CML diagnosis to pregnancy in patients with planned pregnancy was significantly longer than that in patients with unplanned pregnancy (10.6 years vs. 4.1 years, p < .001). In 48 pregnancies that resulted in childbirth, TFR and treatment with IFN-α were chosen in 26 and 17 pregnancies, respectively. Sustained major or deeper molecular response was observed in 18 of 26 pregnancies with TFR. The patients who fulfilled the requirements for TKI therapy discontinuation by European LeukemiaNet recommendations achieved a TFR rate of 77% in pregnancy. Treatment with IFN-α might be effective for patients who are in complete cytogenetic response or deeper response (response rate, 76%).
Pregnancy by TFR or treatment with IFN-α could be a safe and feasible way for patients with CML. However, a substantial duration of treatment with a TKI before conception may be needed for planned pregnancy. Planning and evaluation for pregnancy should be considered at the time of CML onset for female patients with childbearing potential.
患有慢性髓性白血病（CML）的年轻女性患者由于酪氨酸激酶抑制剂（TKIs）的致畸性，在怀孕方面常常面临挑战。
作者对2002年至2020年间经历过怀孕的CML女性患者进行了一项全国性调查。
获得了49名患者70次怀孕的信息。怀孕有三种类型：孕期发生CML（n = 9），大多在接受TKI治疗期间意外怀孕（n = 25），以及在无治疗缓解期（TFR）或接受α干扰素（IFN-α）治疗期间计划怀孕（n = 36）。计划怀孕患者从CML诊断到怀孕的中位时间显著长于意外怀孕患者（10.6年对4.1年，p <.001）。在48次分娩的怀孕中，分别有26次和17次选择了TFR和IFN-α治疗。26次TFR怀孕中有18次观察到持续的主要或更深层次分子反应。根据欧洲白血病网络建议满足TKI治疗停药要求的患者在孕期的TFR率为77%。IFN-α治疗可能对处于完全细胞遗传学缓解或更深缓解的患者有效（缓解率为76%）。
TFR或IFN-α治疗后的怀孕对CML患者可能是一种安全可行的方式。然而，计划怀孕可能需要在受孕前使用TKI进行相当长时间的治疗。对于有生育潜力的CML女性患者，应在CML发病时考虑怀孕的规划和评估。
