Purpose of Review

The goal of this review is to summarize what is known about pregnancy in women with chronic myeloid leukemia (CML): there are very few guidelines regarding how to treat women who are pregnant at the time of CML diagnosis, and similarly, few guidelines regarding family planning for women already on tyrosine kinase inhibitor therapy who might want to start family planning.

Recent Findings

Most patients with CML achieve excellent control with first line tyrosine kinase inhibitor therapy that includes either imatinib, dasatinib, nilotinib, or bosutinib. For men, tyrosine kinase inhibitor (TKI) therapy does not affect sperm number or function, and female partners of men on therapy who become pregnant do not have an increased risk of miscarriage or babies with fetal malformation. However, for women, all TKIs are teratogenic and should be avoided at least in the first trimester of pregnancy. However, a small study suggests that women who have achieved a stable deep response therapy can safely stop therapy prior to a planned pregnancy and may not need any intervention during the pregnancy. Another small study suggests that nilotinib and imatinib have the lowest rate of transfer across the placenta.

Summary

Providing well-documented guidelines for women with CML is challenging as TKI therapy is teratogenic. However, valuable information can be gained from small series of patients as summarized here.

中文翻译：

---

慢性粒细胞白血病患者的计划生育和妊娠

审查目的

本综述的目的是总结关于慢性粒细胞白血病 (CML) 女性妊娠的已知信息：关于如何治疗在 CML 诊断时怀孕的女性的指南很少，同样，关于家庭的指南也很少为可能想要开始计划生育的已经接受酪氨酸激酶抑制剂治疗的女性制定计划。

最近的发现

大多数 CML 患者通过包括伊马替尼、达沙替尼、尼罗替尼或博舒替尼在内的一线酪氨酸激酶抑制剂治疗实现了良好的控制。对于男性，酪氨酸激酶抑制剂 (TKI) 疗法不会影响精子数量或功能，接受治疗的男性女性伴侣怀孕后流产或胎儿畸形的风险也不会增加。然而，对于女性而言，所有 TKI 均有致畸作用，至少应在妊娠的前三个月避免使用。然而，一项小型研究表明，已经获得稳定深度反应治疗的女性可以在计划怀孕前安全地停止治疗，并且在怀孕期间可能不需要任何干预。另一项小型研究表明，尼罗替尼和伊马替尼的胎盘转移率最低。

概括

为患有 CML 的女性提供有据可查的指南具有挑战性，因为 TKI 疗法具有致畸性。然而，可以从此处总结的小样本患者中获得有价值的信息。