1 Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima 960-1295, Japan.
2 Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima 960-1295, Japan.
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35-year-old female patient with chronic myeloid leukemia (CML) wanted
to have a child. She had been treated with imatinib and had achieved
major molecular remission, after which imatinib was intentionally
discontinued, and interferon-α treatment was initiated. After three
failed cycles of artificial insemination with her husband's semen, the
patient underwent treatment with assisted reproductive technology.
After two cycles of in vitro fertilization, two embryos (8-cell stage
and blastocyst) were cryopreserved. The patient again had elevated
major BCR-ABL mRNA levels; thus, infertility treatment was
discontinued. After 18 months of dasatinib treatment, major molecular
remission was again observed, and the patient underwent
vitrified–warmed embryo transfer with a single blastocyst. After that,
she became pregnant. Discontinuation of tyrosine kinase inhibitors
combined with the timely initiation of infertility treatments,
including assisted reproductive technology, might thus be useful for
treating women with CML who wish to become pregnant.
|Figure 1. Clinical course of planned pregnancy in a woman with chronic myeloid leukemia (CML). After three cycles of AIH treatments, she underwent an in vitro fertilization program. After two steps of oocyte retrieval, two embryos, an 8 cell-stage and blastocyst-stage embryo, were vitrified and stored. Due to an increase in major BCR-ABL, infertility treatment was temporally interrupted. After that, dasatinib plus INF-α was administrated until major molecular remission (MMR). After MMR was achieved for 12 months, vitrified–warmed embryo transfer of the 8-cell embryo was performed. Finally, she got pregnant and delivered via cesarean delivery at 37 weeks of gestation. The dotted line indicates the major BCR-ABL mRNA copy number. The solid line indicates the major BCR-ABL IS-NCN. AIH: artificial insemination with husband’s semen, ET: embryo transfer, IFN: interferon, IS-NCN: international scale-normalized copy number, OPU: ovum pickup.|
|Table 1. Reported cases of planned pregnancy in patients with CML with TKI interruption.|