How I manage chronic myeloid leukemia during pregnancy

Abstract

Chronic myeloid leukemia (CML) represents a paradigm of success in targeted therapy, with tyrosine kinase inhibitors (TKIs) revolutionizing patient outcomes. This progress has extended to the management of pregnancy in women with CML, a complex scenario requiring a balance between disease control and fetal safety. Because TKIs are contraindicated during the first trimester due to their teratogenic potential, treatment must be stopped as soon as pregnancy is confirmed, necessitating careful preconception planning and alternative management strategies. This article uses illustrative clinical cases to explore key aspects of CML pregnancy management, including the timing of TKI discontinuation, the feasibility of treatment-free remission, and the role of alternative therapies such as interferon alfa. Additionally, we discuss the challenges of restarting treatment during pregnancy, the TKI selection in subsequent trimesters, and postpartum disease management, including breastfeeding considerations. Through the analysis of real-world cases, we provide insights into the evolving landscape of CML and pregnancy, offering practical guidance on optimizing maternal and fetal outcomes in this unique setting.