Management of CML and Pregnancy in Low-and Middle-income Countries

Chronic myeloid leukemia (CML) is one of the most common types of leukemia observed in adults in low- and middle-income countries (LMICs). While the life expectancy of CML patients in the chronic phase in high-income countries (HIC) countries has nearly matched that of the general population, this is not the case for CML patients in LMICs. Several factors contribute to this disparity, including delayed presentation, delayed diagnosis, poor socioeconomic background, illiteracy, lack of insurance, long travel distances to healthcare facilities, limited availability of CML specialists, and the prevalence of tropical infections such as dengue and malaria. Consequently, management guidelines developed for CML patients in HIC are not always applicable to those in LMICs. The same hold true for CML patients who are pregnant or wish to conceive. This manuscript explores these differences and offers tailored recommendations for pregnancy and CML. Male patients with CML can safely father children, as neither the disease nor tyrosine kinase inhibitors (TKIs) impact pregnancy or affect newborns. However, managing CML in female patients is more complex. Although physicians advise planned pregnancies for CML patients, most pregnancies in LMICs are unplanned. Issues such as whether to continue or stop TKI treatment and which TKI to use are critical considerations. Interferon is regarded as safe during pregnancy but is seldom prescribed due to its high cost. This manuscript aims to address these complexities and provide recommendations for pregnant CML patients in LMICs including India.