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× To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML patient cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below).

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Pregnancy and hydroxyurea

  • Muheez Durosinmi
  • Muheez Durosinmi's Avatar Topic Author
1 year 4 months ago - 1 year 4 months ago #1536 by Muheez Durosinmi
Pregnancy and hydroxyurea was created by Muheez Durosinmi
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
  • Andrey Zaritskey
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1 year 4 months ago - 1 year 4 months ago #1537 by Andrey Zaritskey
Replied by Andrey Zaritskey on topic Pregnancy and hydroxyurea
What we know about HU and pregnancy:
-it was carcinogenic, mutagenic, and teratogenic in animals
-It can cause fetal malformations (partially ossified cranial bones, absence of eye sockets, hydrocephaly, bipartite sternebrae, missing lumbar vertebrae) in animals
-but there are some reports with healthy liveburn (full-term or prematur) - several monthes-years FU - healthy babies, no problems. No major malformations. Hydroxyurea does not cause teratogenic changes in human?
1.J Natl Med Assoc. 2009 Oct;101(10):1046-51. Exposure to hydroxyurea and pregnancy outcomes in patients with sickle cell anemia.
Ballas SK1, McCarthy WF, Guo N, DeCastro L, Bellevue R, Barton BA, Waclawiw MA; Multicenter Study of Hydroxyurea in Sickle Cell Anemia.
2. www.nature.com/leu/journal/v15/n8/full/2402168a.html

Beyond HU - interferon alfa may be useful - many reports in myeloproliferative diseases with success deliveries

ORIGINAL CASE:
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
  • Jorge Cortes
  • Jorge Cortes's Avatar Topic Author
1 year 4 months ago - 1 year 4 months ago #1538 by Jorge Cortes
Replied by Jorge Cortes on topic Pregnancy and hydroxyurea
In instances like this I usually do not use anything if the patient is stable and asymptomatic or minimally symptomatic. I agree that Hydroxyurea is generally safe but the more I can delay the better. In my practice, the WBC alone is not enough to require treatment but rather the overall condition of both the mother and the baby.


ORIGINAL CASE:
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
  • jeff lipton
  • jeff lipton's Avatar Topic Author
1 year 4 months ago - 1 year 4 months ago #1540 by jeff lipton
Replied by jeff lipton on topic Pregnancy and hydroxyurea
Generally I avoid HU in a pregnant woman. I have had several cases like this and I use leukopheresis as needed and put them on interferon which is safe. I have used both regular and pegylated, although I know again that there is some controversy with regard to pegylated and placental accumulation. Between ET and CML, I have had about 2 dozen safe pregnancies, including a couple of IVF pregnancies, with good outcomes and no fetal problems.
In terms of the frequency of leukopheresis, I have used it for several months at up to 3 times per week with no sequelae.
TKIs should be avoided at least during the first 2 trimesters. The 3rd is controversial.
The one question that has not been raised here is whether the woman wants to continue the pregnancy, knowing that she cannot get optimal therapy with a TKI for at least 6-9 months and longer if she breast feeds.


ORIGINAL CASE:
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
  • Andrija Bogdanovic
  • Andrija Bogdanovic's Avatar Topic Author
1 year 4 months ago - 1 year 4 months ago #1543 by Andrija Bogdanovic
Replied by Andrija Bogdanovic on topic Pregnancy and hydroxyurea
I totally agree with several previous comment to this case. The main issue is resources available locally. If Interferon is available this would be the best option we can provide for CML control. in case of severe rise in WBC and/or Plct leukopheresis can control it t some level (e.g. WBC 30-40, Plt 600-700) and should be continues with Interferon treatment.
During many years in my institution in not so rich country (Serbia) we manage pregnancies in females with myeloproliferation and CML predominantly with interferon. Generaly, Interferon side effects are not the obstacle as you do not need doses intended to achieve cytogenetic remission (high dose like 3-5MIU/sqm/d) but those needed to achieve only hematological response even not complete (maintaining WBC up to 20-30 G/L). This could be done by 3MIU daily with even subsequent reduction to 3MIU 3 times weekly. Nowadays plain classical IFN is not so expensive like decades ago.
In case that the mother to be is in chronic phase CML with good prognostic scores, she could postpone imatinib and any other CML specific treatment like HU until delivery. If she wants to breast feed, this can be a challenge as we do not have full information about INF in milk and possible effects on newborn, even it is quite safe in children with CML. Of course, the breastfeeding should be discontinued and further CML management continued by HU and TKI available.


ORIGINAL CASE:
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
  • Francisco Cervantes
  • Francisco Cervantes's Avatar Topic Author
1 year 4 months ago - 1 year 4 months ago #1545 by Francisco Cervantes
Replied by Francisco Cervantes on topic Pregnancy and hydroxyurea
I have had several such patients. I have never usde hydroxyurea, which is recommended to be avoided during pregnancy, especially during the first trimester. When the WBC counts are above 30 x 10e9/L I have used leukapheresis first and, once the counts are below 20 x10e9/L, I followed with interferon until delivery. I have also used interferon several times in pregnant women with essential thrombocythemia or polycythemia vera, without any problem (it doesn’t cross the placental barrier). After delivery, I started a TKI but without breast feeding.

Best regards,

Francisco Cervantes



ORIGINAL CASE:
Hello, I have an urgent case of a 22-year old lady who is 6 weeks pregnant and just confirmed to have chronic myeloid leukaemia in treatable phase. The total leucocyte count stands at 55,0000/ul , platelets 354K and haematocrit 36%. Spleen and liver were not palpable enlarged.

I am tempted to try her on hydroxyurea, based on the following
"Pharmacotherapy. 1999 Dec;19(12):1459-62, Hydroxyurea in two pregnant women with sickle cell anemia.
Byrd DC1, Pitts SR, Alexander CK"

Thank you
Last edit: 1 year 4 months ago by Nicola.
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