Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer
The overwhelming success of tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia (CML) patients has opened a discussion among medical practitioners and the lay public on the real possibility of pregnancy and conception in females and males with CML. In the past 10 years this subject h...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/7/1801 |
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| author | Elisabetta Abruzzese Stefano Aureli Francesco Bondanini Mariavita Ciccarone Elisabetta Cortis Antonello Di Paolo Cristina Fabiani Sara Galimberti Michele Malagola Alessandra Malato Bruno Martino Malgorzata Monika Trawinska Domenico Russo Paolo de Fabritiis |
| author_facet | Elisabetta Abruzzese Stefano Aureli Francesco Bondanini Mariavita Ciccarone Elisabetta Cortis Antonello Di Paolo Cristina Fabiani Sara Galimberti Michele Malagola Alessandra Malato Bruno Martino Malgorzata Monika Trawinska Domenico Russo Paolo de Fabritiis |
| author_sort | Elisabetta Abruzzese |
| collection | DOAJ |
| description | The overwhelming success of tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia (CML) patients has opened a discussion among medical practitioners and the lay public on the real possibility of pregnancy and conception in females and males with CML. In the past 10 years this subject has acquired growing interest in the scientific community and specific knowledge has been obtained “from bench to bedside”. Embryological, pharmacological, and pathophysiological studies have merged with worldwide patient databases to provide a roadmap to a successful pregnancy and birth in CML patients. Male conception does not seem to be affected by TKI therapy, since this class of drugs is neither genotoxic nor mutagenic, however, caution should be used specially with newer drugs for which little or no data are available. In contrast, female patients should avoid TKI therapy specifically during the embryonic stage of organogenesis (5–12 weeks) because TKIs can be teratogenic. In the last 15 years, 41 pregnancies have been followed in our center. A total of 11 male conceptions and 30 female pregnancies are described. TKI treatment was generally terminated as soon as the pregnancy was discovered (3–5 weeks), to avoid exposure during embryonic period and to reduce the risk of needing treatment in the first trimester. Eleven pregnancies were treated with interferon, imatinib or nilotinib during gestation. Nilotinib plasma levels in cord blood and maternal blood at delivery were studied in 2 patients and reduced or absent placental crossing of nilotinib was observed. All of the patients were managed by a multidisciplinary team of physicians with obligatory hematological and obgyn consultations. This work provides an update on the state of the art and detailed description of pregnancy management and outcomes in CML patients. |
| first_indexed | 2024-03-09T11:43:20Z |
| format | Article |
| id | doaj.art-3bb49518601246a19c53d302d051a925 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T11:43:20Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-3bb49518601246a19c53d302d051a9252023-11-30T23:27:03ZengMDPI AGJournal of Clinical Medicine2077-03832022-03-01117180110.3390/jcm11071801Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental TransferElisabetta Abruzzese0Stefano Aureli1Francesco Bondanini2Mariavita Ciccarone3Elisabetta Cortis4Antonello Di Paolo5Cristina Fabiani6Sara Galimberti7Michele Malagola8Alessandra Malato9Bruno Martino10Malgorzata Monika Trawinska11Domenico Russo12Paolo de Fabritiis13Hematology, Sant’Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, ItalyObstetrics and Gynecology, Sant’Eugenio Hospital, ASL Roma 2, 00144 Rome, ItalyLaboratory Medicine, Sant’Eugenio Hospital, ASL Roma 2, 00144 Rome, Italy“Dormant Buds” Association, Obstetrics and Gynecology, San Carlo di Nancy Hospital, 00165 Rome, ItalyPediatrics, Sant’Eugenio Hospital, ASL Roma 2, 00144 Rome, ItalySection of Pharmacology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, ItalyReproduction Pathophisiology and Andrology, Sandro Pertini Hospital, ASL Roma 2, 00157 Rome, ItalyHematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, ItalyUnit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia, University of Brescia, 25123 Brescia, ItalyDivision of Hematology, Ospedali Riuniti Villa Sofia-Cervello, 90146 Palermo, ItalyHematology Unit, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89124 Reggio Calabria, ItalyHematology, Sant’Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, ItalyUnit of Blood Diseases and Bone Marrow Transplantation, Cell Therapies and Hematology Research Program, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia, University of Brescia, 25123 Brescia, ItalyHematology, Sant’Eugenio Hospital, ASL Roma 2, Tor Vergata University, 00144 Rome, ItalyThe overwhelming success of tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia (CML) patients has opened a discussion among medical practitioners and the lay public on the real possibility of pregnancy and conception in females and males with CML. In the past 10 years this subject has acquired growing interest in the scientific community and specific knowledge has been obtained “from bench to bedside”. Embryological, pharmacological, and pathophysiological studies have merged with worldwide patient databases to provide a roadmap to a successful pregnancy and birth in CML patients. Male conception does not seem to be affected by TKI therapy, since this class of drugs is neither genotoxic nor mutagenic, however, caution should be used specially with newer drugs for which little or no data are available. In contrast, female patients should avoid TKI therapy specifically during the embryonic stage of organogenesis (5–12 weeks) because TKIs can be teratogenic. In the last 15 years, 41 pregnancies have been followed in our center. A total of 11 male conceptions and 30 female pregnancies are described. TKI treatment was generally terminated as soon as the pregnancy was discovered (3–5 weeks), to avoid exposure during embryonic period and to reduce the risk of needing treatment in the first trimester. Eleven pregnancies were treated with interferon, imatinib or nilotinib during gestation. Nilotinib plasma levels in cord blood and maternal blood at delivery were studied in 2 patients and reduced or absent placental crossing of nilotinib was observed. All of the patients were managed by a multidisciplinary team of physicians with obligatory hematological and obgyn consultations. This work provides an update on the state of the art and detailed description of pregnancy management and outcomes in CML patients.https://www.mdpi.com/2077-0383/11/7/1801CMLpregnancyplacental transferTKIsPEG-IFNconception |
| spellingShingle | Elisabetta Abruzzese Stefano Aureli Francesco Bondanini Mariavita Ciccarone Elisabetta Cortis Antonello Di Paolo Cristina Fabiani Sara Galimberti Michele Malagola Alessandra Malato Bruno Martino Malgorzata Monika Trawinska Domenico Russo Paolo de Fabritiis Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer Journal of Clinical Medicine CML pregnancy placental transfer TKIs PEG-IFN conception |
| title | Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer |
| title_full | Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer |
| title_fullStr | Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer |
| title_full_unstemmed | Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer |
| title_short | Chronic Myeloid Leukemia and Pregnancy: When Dreams Meet Reality. State of the Art, Management and Outcome of 41 Cases, Nilotinib Placental Transfer |
| title_sort | chronic myeloid leukemia and pregnancy when dreams meet reality state of the art management and outcome of 41 cases nilotinib placental transfer |
| topic | CML pregnancy placental transfer TKIs PEG-IFN conception |
| url | https://www.mdpi.com/2077-0383/11/7/1801 |
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