怀孕期间慢性髓性白血病的管理:证据和治疗算法的审查

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Fadi G Haddad¹, Jennifer Croden¹, Koji Sasaki¹

¹Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX.

Clinical lymphoma, myeloma & leukemia

|August 29, 2025

概括

在怀孕期间治疗慢性髓性白血病 (CML) 需要仔细考虑氨酸激酶抑制剂 (TKI) 的安全性. 一些TKI带来风险,特别是在怀孕早期,需要个性化治疗计划和共同决策.

科学领域:

血液学
癌症学
生殖医学

背景情况:

怀孕期间的费城染色体阳性慢性髓性白血病 (CML) 是一种罕见但复杂的临床挑战.
在怀孕期间治疗CML需要平衡母亲的健康和胎儿的安全性,因为治疗的潜在产性.

研究的目的:

审查各种CML治疗的潜在胎儿毒性,重点是氨酸激酶抑制剂 (TKI) 和替代治疗方法.
为孕妇治疗CML提供指导,考虑不同治疗选择的风险和益处.

主要方法:

对怀孕期间CML治疗的文献综述.
对BCR:ABL1TKIs (imatinib,nilotinib,dasatinib,ponatinib,bosutinib,asciminib) 和替代药物 (干扰素α,尿素) 的治疗效果分析.

主要成果:

由于胎盘转移有限和产风险较低,可以考虑在第二和第三季度使用伊马替尼和尼洛替尼.
由于先天性异常和特殊胎儿疾病的高风险,达沙替尼和波沙替尼是禁忌的.
博苏替尼和阿西米尼的数据有限; 干扰素α和尿素提供了替代的,但效果较差或潜在风险较高的选择.

结论:

怀孕中CML的治疗决定必须是个性化的,优先考虑胎儿安全和母亲健康.
在怀孕期间选择合适的CML疗法时, 进行全面的患者咨询和共同决策至关重要.
男性伴侣使用的TKI在伴侣怀孕中不会对胎儿发育构成风险.

关键词:

BCR::ABL1 其他在CMLCP 怀孕的时间胎儿在怀孕期间

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