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Case Report

Is pregnancy wise after 12-year chemotherapy of chronic myeloid
leukemia woman?

Umesh Das, Gurulingaiah Venkata Giri, Kuntejowdahalli Lakshmaiah, Suresh Tagarapura, Lokanatha Dasappa,
Govind Babu, Linu Abraham Jacob, Suresh Babu
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru 560029, Karnataka, India.
Correspondence to: Dr. Umesh Das, Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru 560029, Karnataka, India.
E-mail: drumesh.das07@gmail.com

ABSTRACT
Diagnosis of leukemia during pregnancy is a dramatic event that poses challenges to the pregnant woman, the family, and physicians.
Chronic myeloid leukemia (CML) comprises up to 10% of pregnancy-associated leukemia. There is no specifi c guideline for CML
management in pregnant women. This study reported a case of successful pregnancy after 12 years of chemotherapy including
tyrosine kinase inhibitor for CML. Pregnancy after 12 years of continuous chemotherapy is rare, which also led a challenge for
medical oncologists and patient as well. This study described the assessment of the risk balance and benefi t and management of
such a patient.

Key words: Chronic myeloid leukemia, imatinib, pregnancy, tyrosine kinase inhibitor

Introduction for 2 months in 2001. Out of patient clinic exam showed
that she had a splenomegaly and moderate hepatomegaly
Chronic myeloid leukemia (CML) occurs as a result and peripheral blood smear, bone marrow aspiration,
of a reciprocal translocation between chromosome and cytogenetic tests all showed abnormalities and,
[1]
22 and chromosome 9. The discovery of tyrosine therefore, she was diagnosed as CML in chronic phase.
kinase inhibitor (TKI) imatinib has revolutionized the Hydroxyurea treatment was started and maintained the
management of a once fatal disease to transform it into
a treatable condition. CML patients in reproductive treatment until 2006, during which period of time she was
age and being treated with imatinib showed to have in complete hematological remission (CHR). In March
contemplating reproductive opportunities that would not 2006, imatinib was given to the patient through Gleevec
have otherwise been possible in the pre-imatinib era. International Patient Assistance Program at a daily dose
The management of CML during pregnancy is a unique of 300 mg and increased to 400 mg in September 2007.
challenge for medical oncologists and requires a balance In 2008, BCR-ABL was 2.29%. In 2009, she lost her
between maternal survival and fetal health during the CHR. Due to fi nancial limitations, imatinib resistance
entire pregnancy. Because imatinib was teratogenic in mutation analysis (IRMA) was not done. In March 2010,
rats, it was strongly advised that effective contraception her BCR-ABL level gone up to 36.76% and the IRMA
should be used during therapy to prevent pregnancy. was performed, but did not show any imatinib resistance
[2]
There are still sparse safety data on newer generation mutations. The imatinib dose was escalated to up to
TKIs such as nilotinib, dasatinib, or bosutinib to be used 600 mg daily. Due to intolerance, her imatinib dose was
to treat a patient during pregnancy. In this study, we are decreased to 400 mg daily. In February 2011, she got
reporting the outcome of a CML patient who became married, but in August 2011, she lost CHR and BCR-ABL
pregnant after receiving chemotherapy for 12 years. had increased to 67.5%; thus interferon (IFN)-alpha 5
MU was added to the treatment remedy in an alternate
Case Report day until July 2012. In October 2012, her BCR-ABL

As an 11-year-old girl, she was presented with loss of This is an open access article distributed under the terms of the Creative
weight and dragging sensation in the left hypochondrium Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows
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Website:
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How to cite this article: Das U, Giri GV, Lakshmaiah K, Tagarapura S,
Dasappa L, Babu G, Jacob LA, Babu S. Is pregnancy wise after
12-year chemotherapy of chronic myeloid leukemia woman? J Cancer
DOI: Metastasis Treat 2015;1:208-10.
10.4103/2394-4722.158433
Received: 09-01-2015; Accepted: 12-05-2015.
208 Journal of Cancer Metastasis and Treatment ¦ Volume 1 ¦ Issue 3 ¦ October 15, 2015 ¦