Pregnancy out Come In the Perspective of Chronic Myeloid Leukemia Patient on Imatinib Therapy: An Experience From India.

Now that imatinib is being used to treat thousands of chronic myeloid leukemia (CML) patients for more than 10 year it is highly probable that many patients will get pregnant during its use. Company warns against any such use. But the fact remains that there is need for planned pregnancies in indicated cases. So we selected few cases both male and female for such pregnancies by interrupting treatment and following the pregnancy closely. Their outcome was studied so that we have an idea about what best could be suggested in such instance.

From November 2002 to May 2010, 634 patients with CML in any stage of the disease were treated with imatinib at our tertiary cancer research institute. Among them 274 were female and 221 were of 17 to 50 years age group. We report information of 8 accidental pregnancies and 10 planned pregnancies involving 18 patients (10 females and 8 males) where pregnancy had occurred while receiving imatinib for the treatment of CML.

Among 10 pregnancies reported in female sufferers there were two spontaneous and one elective abortion all in unplanned group and seven live births including one twin. There was one case of hypospadius which could be surgically corrected. Among the eight male patients whose wives conceived four pregnancies were planned, there was one spontaneous abortion, two elective abortions. The conceptions resulted in the birth of five healthy babies (two females). There was no other identifiable congenital anomaly.

In the patients, who do become pregnant while on treatment, balancing the risk to the fetus of continuing imatinib versus the risk to the mother of interrupting treatment remains difficult. From the fetal perspective, imatinib should be discontinued due to the potential risk of serious developmental abnormalities; from the maternal perspective also there is chance of drug interruption induced cytogenetic relapse. CML patients, in the child bearing age group can do bear children. There was no major foetal anomalies which was documented. In the case of female patients the drug was withheld during the first trimester for concerns regarding potential teratogenecity. In both male and female, in the case of a planned pregnancy the drug should preferably be stopped one month before the time of expected conception.

No relevant conflicts of interest to declare.