Pregnancy among patients with chronic myeloid leukemia treated with imatinib.
OBJECTIVE
Imatinib has potential teratogenicity in animals, but the effect of exposure to imatinib during conception and pregnancy in humans is not known.


METHODS
The records of all patients with chronic myeloid leukemia (CML) treated with imatinib were reviewed. We report the experience on 19 pregnancies involving 18 patients (10 females and eight males) who conceived while receiving imatinib for the treatment of CML.


RESULTS
All female patients discontinued therapy immediately on recognition of pregnancy. Three pregnancies (involving two female patients and one male patient) ended in spontaneous abortion, and one patient had an elective abortion. All other pregnancies were uneventful. Two of the 16 babies had minor abnormalities at or shortly after birth (hypospadias in one baby and rotation of small intestine in one baby) that were surgically repaired. All babies have continued normal growth and development. Among female patients who interrupted therapy, five of nine in complete hematologic remission (CHR) at the time of treatment interruption eventually lost CHR, and six experienced an increase in Philadelphia chromosome-positive metaphases. At a median of 18 months after resuming therapy with imatinib, eight patients had a cytogenetic response (complete in three patients).


CONCLUSIONS
Although there is no evidence that a brief exposure to imatinib during conception and pregnancy adversely affects the developing fetus, most patients lose their response after treatment interruption. Patients receiving imatinib should be advised to practice adequate contraception.
Ault
Patricia
P
Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Kantarjian
Hagop
H
O'Brien
Susan
S
Faderl
Stefan
S
Beran
Miloslav
M
Rios
Mary Beth
MB
Koller
Charles
C
Giles
Francis
F
Keating
Michael
M
Talpaz
Moshe
M
Cortes
Jorge
J
D000022:Abortion, Spontaneous / Q000139:chemically induced; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001549:Benzamides; D000013:Congenital Abnormalities / Q000209:etiology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D008297:Male; D008499:Medical Records; D008677:Metaphase; D010677:Philadelphia Chromosome; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D013723:Teratogens
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D013723:Teratogens; D000068877:Imatinib Mesylate