Báez-de la Fuente E, Arellano-Severiano B

Language: Spanish
References: 19
Page: 342-345
PDF size: 46.11 Kb.

ABSTRACT

Background: Imatinib has changed the natural history of chronic myeloid leukemia. There are women with chronic myeloid leukemia in reproductive age with pregnancy desires. The aim of this case was to report the course and outcome of pregnancy in a patient with chronic myeloid leukemia diagnosis treated with imatinib.
Clinical case: A 32 year old female with diagnosis of chronic myeloid leukemia with follow-up of 11 years. She received standard treatment, but she reported poor adherence; therefore, she received imatinib therapy two years after the diagnosis. The patient stopped the treatment herself because she was looking to be pregnant. She presented amenorrhea, which lasted for six weeks; pregnancy was confi rmed. During a period of 10 months, she remained untreated and there were no symptoms of leukemia progression. The pregnancy was terminated by cesarean section at 35.5 weeks of gestation. The product was born healthy. In the postcesarean visit, the lab showed a cell blood count which reported: hemoglobin 8.7 g/dL, hematocrit 25 %, white blood cell 22,000/µL, platelets 170,000/µL. Since October the patient resumed imatinib 600 mg/day.
Conclusions: The prolonged period of treatment with imatinib had no effect on the pregnancy and the product. The molecular monitoring showed the need to reinstall the treatment once the pregnancy fi nished. The effi cacy and safety of treatment allows patients to fulfi ll life projects that seemed distant in other time.

REFERENCES

1. Lichtman M, Liesveld J. Acute myelogenous leukemia. En: Beutler E, Lichtman M, Coller B, editores. Williams Hematology. Sixth edition. New York, US: McGraw-Hill; 2001. p. 1047-84.

2. Zuazu J, Julia A, Sierra J, Valentin MG, Coma A, Sanz MA, et al. Pregnancy outcome in hematologic malignancies. Cancer. 1991:67(3):703-9.

3. Hehlmann R, Berger U, Hochhaus A. Chronic myeloid leukemia: A model for oncology. Ann Hematol. 2005;84(8):487-97.

4. 4 Cortés J, Kantarjian H. Advanced phase chronic myeloid leukemia. Sem Haematol. 2003;40(1):79-86.

5. Cervera E. Aspectos moleculares de la leucemia mieloide crónica. II. Desarrollo de resistencia molecular a imatinib. Gac Med Mex. 2003;139(2):119.

6. Barnes D, Melo J. Management of chronic myeloid leukemia: Targets for molecular therapy. Sem Hematol. 2003;40(1):34-9.

7. Deininger M, Buchdunge E, Druker BJ. The development of imatinib as a therapeutic agent for chronic myeloid leukemia. Blood. 2005;105(7): 2640-53.

8. Frater JL, Tallman MS, Variakojis D, Druker DJ, Resta D, Riley MB, et al. Chronic myeloid leukemia following therapy with imatinib mesylate (Gleevec). Bone marrow histopathology and correlation with genetic status. Am J Clin Pathol. 2003;119(6):833-41.

9. Jones RL, Judson IR. The development and application of imatinib. Expert Opin Drug Saf. 2005;4(2):183-91.

10. Kantarjian HM, Cortés J, O’Brien S, Giles F, Albitar M, Ríos MB. Imatinib mesylate (STI571) therapy for Philadelphia chromosome-positive chronic myelogenous leukemia in blast phase. Blood. 2002;99(10): 3547-53.

11. Le Gouill S, Talmant P, Milpied N, Daviet A, Ancelot M, Moreau JL, et al. Fluorescence in situ hybridization on peripheral blood specimens in a reliable method to evaluate cytogenetic response in chronic myeloid leukemia. J Clin Oncol. 2000;18(7):1533-8.

12. Verweij J, Judson I, van Oosterom A. STI571: A magic bullet? Eur J Cancer. 2001;37(15):1816-9.

13. 13 Carella A, Beltrami G, Corsetti MT. Autografting in chronic myeloid leukemia. Sem Hematol. 2003;40 (1):72-8.

14. Deininger M, O’Brien SG, Ford JM, Druker BJ. Practical management of patients with chronic myeloid. Leukemia receiving imatinib. J Clin Oncol. 2003;21 (8):1637-47.

15. Cortés J, Giles F, O’Brien S, Thomas D, García- Manero G, Ríos MB, et al. Result of high-dose imatinib mesylate in patients with Philadelphia chromosome-positive chronic myeloid leukemia after failure of interferon-{alpha}. Blood. 2003;102(1): 83-6.

16. Marin D, Goldman JM, Olavarría E, Apperley JF. Transient benefi t only from increasing the imatinib dose in CML patients who do not achieve complete cytogenetic remissions on conventional doses. Blood. 2003;102(7):2702-3.

17. Hensley ML, Ford JM. Imatinib treatment: Specifi c issues related to safety, fertility and pregnancy. Sem Hematol. 2003;40(2 Suppl 2):21-5.

18. Cole S, Kantarjian H, Ault P, Cortés J. Successful completion of pregnancy in a patient with chronic myeloid leukemia without active intervention: A case report and review of literature. Clin Lymphoma Myeloma 2009;9(4):324-7.

19. Pye WM, Cortés J, Ault P, Hatfi eld A, Kantarjian H, Pilot R, et al. The effects of imatinib on pregnancy outcome. Blood. 2008;111(12):5505-8.