Pregnancy among patients with chronic myeloid leukemia treated with imatinib
Pregnancy among patients with chronic myeloid leukemia treated with imatinib
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DOI：
10.1200/jco.2005.04.6557
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发表时间：
2006-03-01
影响因子：
45.3
通讯作者：
Cortes, J
中科院分区：
文献类型：
--
作者：
Ault, P;Kantarjian, H;Cortes, J
目的伊马替尼对动物具有潜在的致畸性，但在人类受孕和妊娠期间暴露于伊马替尼的影响尚不清楚。患者和方法回顾了所有接受伊马替尼治疗的慢性粒细胞白血病（CML）患者的记录。我们报告了 19 例妊娠的经验，涉及 18 名患者（10 名女性和 8 名男性），他们在接受伊马替尼治疗 CML 时怀孕。结果 所有女性患者在发现怀孕后立即停止治疗。 3例妊娠（包括2例女性患者和1例男性患者）以自然流产告终，1例患者选择性流产。所有其他怀孕都平安无事。 16 名婴儿中有 2 名在出生时或出生后不久出现轻微异常（一名婴儿尿道下裂，一名婴儿小肠旋转），并通过手术修复。所有婴儿都继续正常生长和发育。在中断治疗的女性患者中，治疗中断时达到完全血液学缓解 (CHR) 的九名女性患者中，有五名最终失去了 CHR，六名患者的费城染色体阳性中期有所增加。恢复伊马替尼治疗后平均 18 个月，8 名患者出现细胞遗传学反应（3 名患者完成）。 结论 尽管没有证据表明在受孕和怀孕期间短暂接触伊马替尼会对发育中的胎儿产生不利影响，但大多数患者在治疗中断后失去反应。应建议接受伊马替尼治疗的患者采取适当的避孕措施。
Purpose Imatinib has potential teratogenicity in animals, but the effect of exposure to imatinib during conception and pregnancy in humans is not known.Patients and Methods The records of all patients with chronic myeloid leukemia (CML) treated with imatinib were reviewed. We report the experience on 19 pregnancies involving 18 patients (10 females and eight males) who conceived while receiving imatinib for the treatment of CML.Results All female patients discontinued therapy immediately on recognition of pregnancy. Three pregnancies (involving two female patients and one male patient) ended in spontaneous abortion, and one patient had an elective abortion. All other pregnancies were uneventful. Two of the 16 babies had minor abnormalities at or shortly after birth (hypospadias in one baby and rotation of small intestine in one baby) that were surgically repaired. All babies have continued normal growth and development. Among female patients who interrupted therapy, five of nine in complete hematologic remission (CHR) at the time of treatment interruption eventually lost CHR, and six experienced an increase in Philadelphia chromosome-positive metaphases. At a median of 18 months after resuming therapy with imatinib, eight patients had a cytogenetic response (complete in three patients).Conclusion Although there is no evidence that a brief exposure to imatinib during conception and pregnancy adversely affects the developing fetus, most patients lose their response after treatment interruption. Patients receiving imatinib should be advised to practice adequate contraception.