7 replies to this topic

[Trey]

Here are some recent articles about pregnancy and CML in the era of TKI therapy:

 

http://www.bloodjour...so-checked=true

 

http://www.ncbi.nlm....les/PMC4010610/

 

http://www.jscimedce...atment-1023.pdf

 

http://ispub.com/IJO/7/2/6076

 

http://jhoponline.co...-with-nilotinib

 

http://jcmtjournal.c...ticle/view/1194

 

 

[Frogiegirl]

Ofcoarse I'm the first one to browse your refrences lol. ...I had no idea you could resume tki after 15 weeks of pregnancy?

[Chrissy_Z]

Thank you

[Trey]

The data about taking TKI drugs during pregnancy is limited.  Most Oncs would recommend against it.  There is risk, but it is hard to quantify due to lack of data.  A fetus is made of fast growing cells, and these TKI drugs target fast growers.  There is much that is not known about the issue.  Using TKI drugs during pregnancy would probably only be done if the mother loses response very quickly and interferon does not work well enough.  These can be hard choices.  A woman can easily lose MMR in less than 9 months, and some have lost CCyR during pregnancy which is a real hazard to her.  That is why starting a pregnancy while having CML should be very carefully pondered.  After the pregnancy Oncs will also discourage breast feeding. 

[Chelsi_H]

I am currently 18 weeks pregnant. My doctors all agreed to see if I can make it through the pregnancy without treatment. They advised that the treatments have horrible side effects and was no guarantee on what it could do to the baby.

[Trey]

If Interferon is needed for your health, others here have used it during pregnancy.  It causes flu-like symptoms, which is not fun on top of the pregnancy.  But if it is needed, it is probably the best treatment option available.  Interferon is a natural substance in the human body, but in much smaller amounts than treatment levels.

[Gail's]

So Trey, I'm not as worried about CML without treatment in pregnancy. The reason is that most of us walked around a long time with CML before we started treatment and the stop TKI trials have shown a quick response if a patient needed to resume medication. If I need to stop TKI treatment for a good reason, I do not fear croaking. As you've pointed out in past posts, it's not like antibiotics that can create drug resistant organisms. What is your chief worry about the TKI break for surgery or pregnancy or whatever requires it?

[Trey]

This post only covers pregnancy cessation, which is a fixed time without the ability to simply restart the TKI drug without risk to the fetus.  A loss of CCyR early during the pregnancy and continuation after that without any treatment is the concern.  If that happens CML progression can occur, making regained response to TKI drugs less likely, and at some point unlikely.  That progression can occur fairly quickly for some people, and has for women during pregnancy.  This is why pregnancy should start with and extended PCRU whenever possible.