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Pregnancy while on TKI

Dragana Milojkovic
Topic Author

6 days 22 hours ago #2135 by Dragana Milojkovic

Pregnancy while on TKI was created by Dragana Milojkovic

Female patient, age 39, CML-CP, int ELTS, diagnosed 3 yrs ago, no high-risk features, on dasatinib 100mg in stable MMR for 18 months. No previous pregnancies. Has read the new ELN 25 recommendations and the NCCN 26 guidelines. Should the advice be to try to conceive on TKI, and stop when pregnancy is confirmed?

Elisabetta Abruzzese
Topic Author

6 days 22 hours ago #2136 by Elisabetta Abruzzese

Replied by Elisabetta Abruzzese on topic Pregnancy while on TKI

The answer is yes — we prefer not to risk a relapse while trying to conceive. Since most relapses occur within 3–6 months, and the first 3 months of pregnancy carry the greatest teratogenic risk, we recommend stopping the TKI at the time of the first positive pregnancy test (around 3–5 weeks of gestation). Of course, the patient should be advised to monitor for pregnancy carefully so she can discontinue the TKI promptly.

We also suggest initiating IFN once pregnancy is confirmed, without waiting for an increase in transcript levels, as it is unlikely she will maintain MMR after only 18 months of treatment. Her age is borderline, so I would recommend moving forward without delaying further.

Daniela Žáčková
Topic Author

6 days 22 hours ago #2137 by Daniela Žáčková

Replied by Daniela Žáčková on topic Pregnancy while on TKI

If the patient, given her advanced age for a first pregnancy, does not wish to continue waiting to achieve a deeper molecular response, which would always represent a safer scenario, the proposed approach can be considered acceptable: to continue dasatinib therapy, perform regular pregnancy testing, and discontinue treatment immediately upon the first positive result.

Salam Al kindi
Topic Author

5 days 13 hours ago - 3 days 17 hours ago #2138 by Salam Al kindi

Replied by Salam Al kindi on topic Pregnancy while on TKI

We had one lady who conceived while on Dasatinib with disastrous consequences (macerated baby) etc., and I will definitely recommend not to try to conceive on Dasatinib, and best option is interferon, although we had successful pregnancies with Imatinib.

Last edit: 3 days 17 hours ago by arlene.

Prof. Hemant Malhotra
Topic Author

5 days 41 minutes ago #2139 by Prof. Hemant Malhotra

Replied by Prof. Hemant Malhotra on topic Pregnancy while on TKI

I would like to know if the patient is in deep molecular remission or not, and if yes, for how long? My advice would be to wait for one or preferably two more years before attempting pregnancy. The option of embryo freezing can also be considered. However, if the patient is adamant about conceiving right away, then the strategy suggested by you could be considered, with close monitoring of bcr/abl transcripts, and avoiding TKI exposure during the 1st trimester of pregnancy.

Jeff Lipton
Topic Author

3 days 16 hours ago #2140 by Jeff Lipton

Replied by Jeff Lipton on topic Pregnancy while on TKI

Far be it from me to disagree with the pregnancy experts who have commented here. The two issues are firstly, how deep is MMR? The likelihood of rebound of disease on stopping TKI if the response is in the 0.1% IS range is very high. Secondly, IFN takes a while to capture once started. The biggest risk of TKI related teratogenicity is in the first trimester, safest in the third and variable in the second. Let me toss an idea into the discussion. Why not start IFN immediately while still on TKI, then attempt pregnancy and stop TKI immediately on detecting pregnancy while doing "routine" pregnancy testing. There is some evidence from the German trials that adding IFN to a TKI may be beneficial and having it on board may (wishfully thinking?) reduce the chances of rebound. IFN as well is sage in pregnancy, and as well, there is evidence that it may help with fetal retention (the placenta secretes IFNs) at least in the thrombocytosis literature.

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