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.

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.

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?