Management of chronic myelogenous leukemia in pregnancy

Discovery of tyrosine kinase inhibitors has led to improvement in survival of chronic myelogenous leukemia (CML) patients. Many young CML patients encounter pregnancy during their lifetime. Tyrosine kinase inhibitors inhibit several proteins that are known to have important functions in gonadal development, implantation and fetal development, thus increasing the risk of embryo toxicities. Studies have shown imatinib to be embryotoxic in animals with varying effects in fertility. Since pregnancy is rare in CML, there are no randomized controlled trials to address the optimal management of this condition. However, there are several case reports and case series on CML in pregnancy. At the present time, there is no consensus on how to manage different pregnancy situations in CML. In this article, we review current literature on CML in pregnancy, discuss the effects of several tyrosine kinase inhibitors on fertility and pregnancy and suggest an evidence-based treatment of CML in pregnancy.