A Successful Pregnancy in a Patient with Chronic Myeloid Leukemia Exposed to Nilotinib during the Entire First Trimester of Pregnancy

The occurrence of pregnancy in chronic myeloid leukemia in pregnancy is rare and its management poses a clinical challenge for physicians treating these patients. . In February 2010 during a routine examination, a 25-year-old woman was diagnosed with Philadelphia-positive CML in chronic phase. She was normal upon physical examination without clinical symptoms. Laboratory studies showed hemoglobin 10.7 g/dL, platelets 101 109 L and white cell count 54.8 109 L with a differential revealing 7 % myelocytes, 2 % promyelocytes, 15 % metamyelocytes, 28 % band cells, 39 % neutrophils, 3 % eosinophils, 0 % basophils, 4 % lymphocytes and 2 % monocytes. The diagnosis of CML was confirmed based on bcr-abl mRNA transcript detection and conventional chromosome banding, which revealed a 46, XY, t (9, 22) karyotype. The patient started treatment with Imatinib 100 mg, 4 tabs po/d. In march 2013 the patient under Imatinib treatment lost MMR so we started treatment with Nilotinib 300 mg/po/d. In Decemeber 2013, the patient was in complete cytogenetic remission and major molecular response. In January 2014 the patient came for a routine visit in our clinic and she revealed she became pregnant while she was on nilotinib. The pregnancy was identified at 13weeks. Because the patient elected to continue her pregnancy, nilotinib was stopped immediately, and no further treatment was given until delivery. Neither obstetrical complications nor structural malformations in neonates was observed. The babys growth and development have been normal. Although this experience is limited to a single patient, the success of this patient demonstrates that the management of chronic myeloid leukemia in pregnant women may be individualized based on the relative risks and benefits of the patient and fetus.