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Table 1: Recommendation of treatment as per American   hematological  disorders.  In:  Turner  TL,  editor.  Perinatal
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            Prior to conception  No negative data on imatinib in   4.   Rothman  LA,  Cohen  CJ,  Astarloa  J.  Placental  and  fetal
                                male patients                     involvement  by  maternal  malignancy:  a  report  of  rectal
                                IFN for male and female patients  carcinoma  and  review  of  the  literature.  Am J Obstet Gynecol
            First and second trimester  Low-dose IFN 3 million IU three   1973;116:1023-34.
                                times /week, adjusted to cell counts       5.   Lichtman  M,  Liesveld  J.  Acute  Myelogenous  Leukemia.
                                and tolerability                  Williams Hematology. 6th ed. New York: McGraw-Hill; 2001.
                                                                  p. 1047-84.
                                Avoid PEG-IFN, leukapheresis in
                                case of high leukocytes       6.   Doll DC, Ringenberg QS, Yarbro JW. Management of cancer
            Third trimester     IFN                               during pregnancy. Arch Intern Med 1988;148:2058-64.
                                                                  7.   Buekers  TE,  Lallas  TA.  Chemotherapy  in  pregnancy.
                                Hydroxyurea if loss of            Obstet Gynecol Clin North Am 1998;25:323-9.
                                hematologic response          8.   Zuazu J, Julia A, Sierra J, Valentin MG, Coma A, Sanz MA,
            Breast feeding period  IFN                            Batlle  J,  Flores  A.  Pregnancy  outcome  in  hematologic
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                                                              9.   Ault  P,  Kantarjian  H,  O’Brien  S,  Faderal  S,  Beran  M,
            check for loss of molecular response.  During lactation,   Rios M, Koller C, Giles F, Keating M, Talpazand M, Cortes J.
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            TKI  is  contraindicated,  if  the  patient  is  on  TKI;  then   Pregnancy  among  patients  with  chronic  myeloid  leukemia
                                                                  treated with imatinib. J Clin Oncol 2006;24:1204-8.
            she  should  avoid  breastfeeding.  In  our  patient,  she   10.  Pye  SM,  Cortes  J, Ault  P,  Hatfi eld A,  Kantarjian  H,  Pilot  R,
            was  on  chemotherapy  with  either  hydroxyurea  IFN  or   Rosti  G,  Apperley  JF.  The  effects  of  imatinib  on  pregnancy
            imatinib for the last 12 years. Successful pregnancy after   outcome. Blood 2008;111:5505-8.
            continuous  chemotherapy  for  12  years  is  very  rare.  Our          11.  Cortes  J,  O’Brien  S,  Ault  P,  Borthakur  G,  Jabbour  E,
            patient  was  diagnosed  as  CML  at  age  11,  which  is  also   Bradley-Garelik  B,  Debreczeni  K,  Yang  D,  Liu  D,
            quite  uncommon.  Her  young  age  may  have  contributed   Kantarjian  H.      Pregnancy  outcomes  among  patients  with
            to a better clinical outcome.                         chronic  myeloid  leukemia  treated  with  dasatinib.  Blood
                                                                  2008;112:abstract 3230.
            The  treatment  of  leukemia  in  pregnancy  poses  a   12.  Cole S, Kantarjian H, Ault P, Cortés JE. Successful completion
            signifi cant  challenge  for  medical  oncologists  as  well   of  pregnancy  in  a  patient  with  chronic  myeloid  leukemia
            as  patients.  Our  patient  received  all  possible  treatment   without  active  intervention:  a  case  report  and  review  of  the
                                                                  literature. Clin Lymphoma Myeloma 2009;9:324-7.
            options  and  achieved  a  long-term  remission.  Although   13.  Conchon M, Sanabani SS, Serpa M, Novaes MM, Nardinelli L,
            this experience is limited to a single patient, data on this   Ferreira  PB,  Dorliac  PE,  Bendit  I.  Successful  pregnancy  and
            patient indicate that CML management during pregnancy   delivery in a patient with chronic myeloid leukemia while on
            may  be  individualized  based  on  a  balance  between   dasatinib therapy. Adv Hematol 2010;2010:136252.
            relative risks and benefi ts to the patient and fetus.  14.  Novartis  Pharmaceuticals  Corporation.  Tasigna  (nilotinib)
                                                                  [package  Insert].  East  Hanover:  Novartis  Pharmaceuticals
            Financial support and sponsorship                     Corporation;  2007.  Available  from:  https://www.pharma.
                                                                  us.novartis.com/product/pi/pdf/tasigna.pdf.  [Last  accessed  on
            Nil.                                                  2015 Sep 30].

            Confl icts of interest                             15.  Conchon  M,  Sanabani  SS,  Bendit  I,  Santos  FM,  Serpa  M,
                                                                  Dorliac-Llacer  PE.  Two  successful  pregnancies  in  a  woman
            There are no confl icts of interest.                   with chronic myeloid leukemia exposed to nilotinib during the
                                                                  fi rst trimester of her second pregnancy: case study. J Hematol
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            210                                   Journal of Cancer Metastasis and Treatment  ¦  Volume 1 ¦ Issue 3 ¦ October 15, 2015 ¦
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