怀孕期间出现的CML不同治疗策略的预期和结果
H F Robertson1,2, D Milojkovic1,2, N Butt3
1Centre for Haematology, Imperial College London, London, UK.
British journal of haematology
|May 3, 2024
概括
在怀孕期间诊断慢性髓性白血病 (CML) 是罕见的,但管理是可能的. 像干扰素-α和白皮化等治疗方法是安全的,一些氨酸激酶抑制剂 (TKI) 在怀孕后期表现出潜力.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 生殖医学 生殖医学
背景情况:
- 在怀孕期间诊断慢性骨髓性白血病 (CML) 存在独特的挑战,原因是氨酸激酶抑制剂 (TKIs) 由于原性而具有历史的禁忌.
- 管理决策需要平衡母亲和胎儿未经治疗的CML的风险与原药物的潜在风险.
- 关于怀孕期间诊断的CML的管理和结果的文献有限.
研究的目的:
- 报告怀孕期间诊断的22例慢性髓性白血病 (CML) 的管理和结果.
- 为临床医生提供有关妊娠期间血液学参数和治疗预期的数据.
- 评估各种治疗方式的安全性和有效性,包括干扰素α,白皮化和某些TKI,在孕妇CML患者中.
主要方法:
- 从2002年到现在,对22名被诊断患有CML的患者进行了回顾性病例系列分析.
- 对所采用的治疗策略的审查,包括警等待,干扰素-α,白细胞体,基胺和伊马替尼布.
- 监测母亲的血液学参数和胎儿的结果,包括评估胎儿的异常.
主要成果:
- 在22例怀孕中,有21例孕育出了健康的婴儿;有1例患者流产.
- 在大多数接受治疗的患者中使用了INTERFERON-ALFA和LEUCAPHERESIS,并且在整个怀孕期间通常是安全的.
- 一名患者在26周接受了伊马替尼,另一名患者在第三个三个月接受了氧化碳胺,没有报告与治疗相关的胎儿异常. 17名患者在一线TKI治疗中获得了主要的分子响应.
结论:
- 在怀孕期间诊断的慢性髓性白血病 (CML) 可以有效地管理,对母亲和孩子都有安全的结果.
- 干扰素-阿尔法和白皮化已被确立为怀孕期间的安全治疗选择.
- 某些氨酸激酶抑制剂 (TKIs) 可能在特殊情况下在怀孕后期阶段被考虑,这需要进一步调查它们的安全性.
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