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CHRONIC MYELOGENOUS LEUKEMIA

Chronic myeloid leukemia diagnosed in pregnancy: management and outcome of 87 patients reported to the European LeukemiaNet international registry

Leukemia volume 38, pages 788–795 (2024)Cite this article

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Abstract

The management of chronic myeloid leukemia (CML) diagnosed during pregnancy is a rare and challenging situation. We report the treatment and outcome of 87 cases diagnosed in chronic phase from 2001–2022 derived from the largest international observational registry, supported by the European LeukemiaNet (ELN), of 400 pregnancies in 299 CML women. Normal childbirth occurred in 76% without an increased rate of birth abnormalities or life-threatening events, including in patients untreated or treated with interferon-α and/or imatinib in 2nd–3rd trimester. The low birth weight rate of 12% was comparable to that seen in the normal population. Elective and spontaneous abortions occurred in 21% and 3%, respectively. The complete hematologic response rate before labor was 95% with imatinib and 47% with interferon only. No disease progression during pregnancy was observed, 28% of the patients switched their therapy at varying times after delivery. Treatment options balance the efficacy and safety for mother and infant: interferon-α can commence in the 1st trimester and continued throughout in cases of good disease control and tolerability. Because of limited placental crossing, selected tyrosine kinase inhibitors (imatinib and nilotinib) seem to be safe and effective options in 2nd and 3rd trimester while hydroxycarbamide offers few benefits.

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Fig. 1: Changes in pregnancy outcome and therapy in a period between 2001 and 2022 year.
Fig. 2: Therapy on 66 women with CML onset during pregnancy.

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Data availability

The data supporting the findings of this study are not openly available to preserve individuals privacy under the European General Data Protection Regulation. However, they can be obtained from the corresponding author upon reasonable request and permission.

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Acknowledgements

The authors express their gratitude to the colleagues who treated and consulted patients within the multidisciplinary team. Our warm gratitude to the patients and their children. On behalf of ELN Pregnancy Registry Committee we express our special gratitude for the contribution to collecting cases for the ELN Pregnancy Registry to Dr. Dong-Wook Kim from Catholic Hematology Hospital, Seoul St. Mary’s Hospital, Seoul, S. Korea, Dr. Konstantin Kotlyarchuk from SI ‘Institute of Blood Pathology and Transfusion Medicine UAMS, Lviv, Ukraine and Dr. Penka Ganeva from Specilaized Hospital for Active Treatment of Hematological Diseases, Sofia, Bulgaria. We are grateful to Sandro Pittori for management of the REDCap database in the international registry. We thank Mr. Christophe Bouvier, datamanager, for data collection in Lyon, France. We thank Yulia Chabaeva and Sergey Kulikov from National Medical Hematology Research Center, Moscow, for the data management and express our special gratitude to «National Hematological Society» for promoting the development of hematology, transfusiology and bone marrow transplantation in Russian Federation. JFA acknowledges the support of the Imperial College NIHR Biomedical Research Centre Our special thanks to Professor Rudiger Hehlmann for many years of inspiring support for ELN international cooperation.

Funding

The study was supported by European LeukemiaNet.

Author information

Authors and Affiliations

  1. National Medical Research Center for Hematology, Moscow, Russian Federation

    Ekaterina Chelysheva & Anna Turkina

  2. Centre for Haematology, Imperial College London, London, UK

    Jane Apperley & Harry F. Robertson

  3. Department of Medical Oncology/ Hematology Section, National Centre For Cancer Care & Research, Doha, Qatar

    Mohamed A. Yassin

  4. Service d’hématologie Adulte and FiLMC Hôpital Saint-Louis, Paris, France

    Delphine Rea

  5. Hematology department and INSERM 1052 CRCL, Centre Léon Bérard, Lyon, France

    Franck E. Nicolini

  6. Division of Hematology, University Hospital “Ospedale di Circolo e Fondazione Macchi - ASST Sette Laghi”, Varese, Italy

    Daniela Barraco

  7. Republician Specilized Scientific and Practical Medical Centre of Hematology, Tashkent, Uzbekistan

    Khamida Kazakbaeva & Sukhrob Saliev

  8. Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel

    Adi Shacham Abulafia

  9. Department of Haematology, Sultan Qaboos University, Muscat, Oman

    Salam Al-Kindi

  10. Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, England, UK

    Jennifer Byrne

  11. Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy

    Marco Cerrano

  12. FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I.Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

    Roman Shmakov & Evgenia Polushkina

  13. Hematology, S. Eugenio Hospital, Tor Vergata University, ASL Roma2, Rome, Italy

    Paolo de Fabritiis, Malgorzata Monika Trawinska & Elisabetta Abruzzese

Authors
  1. Ekaterina Chelysheva
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Contributions

EC and EA were responsible for designing the study protocol, collecting and extracting the data and interpreting results. EC, JA, AT and EA were responsible for preparing the initial report. All the co-authors contributed into data collection and were involved into manuscript preparation.

Corresponding author

Correspondence to Ekaterina Chelysheva.

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Competing interests

EC – speaker: Novartis, Pfizer, R-Pharm, consultancy: Ascentage Pharma, JA – speaker: Novartis, Bristol Myers Squibb, Incyte, honoraria: Novartis, Bristol Myers Squibb, Incyte, Research Funding: Pfizer, Incyte, AT – speaker: Novartis, Pfizer, R-Pharm, Amgen, consultancy/advisory board: Novartis, DR – Novartis, Incyte, Pfizer, Terns, FEN – consultancy: Sun Pharma Ltd, Novartis, speaker: Incyte Biosciences, board entity: Incyte Biosciences, Pfizer, Novartis, BMS-Celgene, research fundings: Incyte Biosciences, Novartis, ASA – consultancy: Novartis, JB – honoraria: Novartis, Incyte, Pfizer, MC – advisory board: Insight, Novartis, Italfarmaco, speaker: Servier, Abbvie, Janssen, PF – consultancy: Jazz, Jannsen, Abbvie, MMT – consultancy: Novartis, Takeda, EA – consultancy: BMS, Novaris, Incyte, Pfizer, advisory: BMS, Novaris, Incyte, Pfizer, SAK, MAY, DB, KhK, SS, HFR, RS and EP – nothing to disclose.

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Chelysheva, E., Apperley, J., Turkina, A. et al. Chronic myeloid leukemia diagnosed in pregnancy: management and outcome of 87 patients reported to the European LeukemiaNet international registry. Leukemia 38, 788–795 (2024). https://doi.org/10.1038/s41375-024-02183-0

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