Perspectives on Drug Development for the Treatment of Chronic Myeloid Leukemia in Pregnant Patients and Patients Who Are Breastfeeding (2024)

FAQs

How is chronic myeloid leukemia treated in pregnancy? ›

Treatment options considered safe during pregnancy include leukapheresis and IFN. Treatment with IFN-α controls the high cell mass in the majority of newly diagnosed patients with CML. However, the degree of response ranges from no 'hematologic' response to complete suppression of the leukemic clone.

The most common treatment is a type of targeted cancer drug called a tyrosine kinase inhibitor (TKI). There are several different TKIs. The most common drug for CML is imatinib (Glivec). But your doctor might suggest a different TKI such as dasatanib (Sprycel) or nilotinib (Tasigna).

Twenty of 46 pregnancies (43%) resulted in live births, with delivery of a normal infant at term in 15 (33%) and abnormal pregnancies in 5 (11%). Pregnancies were terminated in 26 of 46 cases (57%): 18 elective and 8 spontaneous abortions.

Chemotherapy is the main treatment for AML. Doctors consider chemotherapy generally safe for a fetus during the second and third trimesters of pregnancy. However, in the first trimester, chemotherapy can be harmful to a fetus and may cause : fetal death.

Pregnant women with leukaemia need to be managed by a multidisciplinary team that includes haematologists, obstetricians, neonatologists, anaesthetists and pharmacists in order to manage all the treatments required. Treatment during the first trimester can be associated with congenital anomalies and miscarriage.

First-line treatment

If you're diagnosed in the chronic phase, your first treatment will usually be a regular standard dose of one of three types of TKI: imatinib, dasatinib or nilotinib.

The most common treatment for chronic myeloid leukaemia (CML) is a type of targeted cancer drug called a tyrosine kinase inhibitor (TKI). Common TKIs for CML include imatinib, bosutinib, dasatinib and nilotinib.

The FDA granted accelerated approval in December 2023 to a new kind of BTK inhibitor, pirtobrutinib (Jaypirca), for adults with CLL or small lymphocytic lymphoma (SLL) who have had at least two prior lines of therapy.

A diagnosis of CML during pregnancy is not an uncommon occurrence; approximately 10% of pregnancy-related leukemias are CML, and 20% of pregnancy-related CML is in patients diagnosed during pregnancy.

Is imatinib safe in pregnancy? ›

Around 200 women taking imatinib in early pregnancy have been studied. While most of their babies were healthy, a handful had a similar pattern of birth defects. This suggests that in rare cases, imatinib might affect the unborn baby's development.

However, a new drug, asciminib, has shown promising results as a safer and more effective treatment for patients with newly diagnosed CML. The phase 3 ASC4FIRST trial included 405 patients recently diagnosed with chronic phase CML.

The first-line treatment for CML is tyrosine kinase inhibitors (TKIs), a type of targeted therapy drug. TKIs include : imatinib (Gleevec) dasatinib (Sprycel)

The standard treatment of choice for chronic phase CML is a TKI: either the first-generation TKI imatinib, which is a specific small-molecule inhibitor of BCR-ABL in all phases of CML, or a second-generation TKI—nilotinib (Tasigna), dasatinib (Sprycel), or bosutinib (Bosulif).

Treatment of chronic phase chronic myelogenous leukemia may include the following: Targeted therapy with a tyrosine kinase inhibitor (imatinib mesylate, nilotinib, dasatinib, bosutinib). High-dose chemotherapy with donor stem cell transplant. Chemotherapy.

Growing numbers of CML patients of childbearing age are living in stable remissions and are considering having children while being treated for CML. There is no risk that parents will pass the Ph chromosome onto their children. Generally, there are no concerns for men on TKIs associated with having children.

The main treatment for most types of AML is chemotherapy, sometimes along with a targeted therapy drug. This might be followed by a stem cell transplant. Other drugs (besides standard chemotherapy drugs) may be used to treat people with acute promyelocytic leukemia (APL).

First-line treatment

If you're diagnosed in the chronic phase, your first treatment will usually be a regular standard dose of one of three types of TKI: imatinib, dasatinib or nilotinib.