Unintended pregnancy for female patients with chronic myeloid leukemia (CML) raises the discussion of treatment choices due to the teratogenicity of tyrosine kinase inhibitor (TKI). We report 51 accidental pregnant CML chronic phase (CP) patients with TKI withdrawal immediately after pregnancy from December 2010 to February 2024 to observe the effect of short exposure to TKI on the fetus and the infant outcomes. 59 pregnancies resulted in 100% normal childbirth without birth abnormalities. The median TKI exposure duration was 4 (4–20) weeks in 58 pregnancies, and one pregnancy avoided TKI exposure due to treatment discontinuation of the patient with treatment-free remission (TFR). All newborns had normal birth weight except one premature infant with low birth weight less than the 10th percentile. Up to now, all the children are in good health. 13 (25.5%) and 30 (58.8%) patients had achieved major molecular response (MMR) and deep molecular response (DMR) at pregnancy, respectively. After TKI discontinuation, loss of MMR and complete hematologic response occurred in 6 (46.2%) and 2 (25.0%) patients at delivery, respectively. 38 patients resumed TKI treatment after delivery, and 13 patients without DMR loss sustained TFR after delivery. The median time to regain MMR and DMR were 3 (2–6) months and 6 (1–28) months, respectively. These results demonstrate that TKI discontinuation during pregnancy is feasible for CML-CP patients, and short TKI exposure of pregnant patients has little influence on children’s growth and development.

中文翻译：

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妊娠女性慢性粒细胞白血病患者短期暴露于酪氨酸激酶抑制剂后的结果


由于酪氨酸激酶抑制剂 (TKI) 的致畸性，慢性粒细胞白血病 (CML) 女性患者的意外怀孕引发了治疗选择的讨论。我们报告了2010年12月至2024年2月51例意外怀孕且妊娠后立即停药的CML慢性期（CP）患者，观察短期暴露于TKI对胎儿和婴儿结局的影响。 59 例妊娠的分娩率 100% 正常，无出生异常。 58 例妊娠中，中位 TKI 暴露持续时间为 4 (4-20) 周，其中 1 例妊娠因无治疗缓解 (TFR) 患者停止治疗而避免了 TKI 暴露。除一名早产儿出生体重低于第 10 个百分点外，所有新生儿出生体重均正常。截至目前，孩子们均身体健康。 13 名 (25.5%) 和 30 名 (58.8%) 患者在妊娠时分别达到主要分子缓解 (MMR) 和深度分子缓解 (DMR)。停用 TKI 后，分娩时分别有 6 名 (46.2%) 和 2 名 (25.0%) 患者出现 MMR 丧失和完全血液学缓解。 38 名患者在产后恢复 TKI 治疗，13 名没有 DMR 丢失的患者在产后维持 TFR。恢复 MMR 和 DMR 的中位时间分别为 3 (2-6) 个月和 6 (1-28) 个月。这些结果表明妊娠期停用TKI对于CML-CP患者是可行的，且妊娠期患者短期TKI暴露对儿童生长发育影响不大。