Maternal and Foetal Outcomes of Newly Diagnosed Chronic Myeloid Leukemia During Pregnancy and its Long-Term Impact

IF 0.9 4区医学

Indian Journal of Hematology and Blood Transfusion Pub Date : 2024-04-05 DOI:10.1007/s12288-024-01743-9

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引用次数: 0

Abstract

Diagnosing Chronic Myeloid Leukemia (CML) during pregnancy presents challenges for both haematologists and obstetricians. Limited data exists regarding the management of pregnancy-associated CML in low- and middle-income countries (LMICs). This study aimed to assess pregnancy, foetal, and long-term disease outcomes in female patients newly diagnosed with CML in the chronic phase (CML-CP) during pregnancy. A retrospective analysis was conducted on female CML-CP patients presenting between January 2002 and December 2022 at our institution. Inclusion criteria encompassed patients newly diagnosed with CML-CP during pregnancy. Data pertaining to pregnancy outcomes, foetal development, and disease progression were analysed through a comprehensive review of medical records. Among the female CML patients, thirteen were diagnosed with CML-CP during pregnancy. The median patient age was 24 years (range: 20–35). Diagnoses occurred in the first trimester for six patients, the second trimester for three, and the third trimester for four. Outcomes included five elective terminations (38.5%), five pre-term deliveries (38.5%), and three full-term deliveries (23.1%). Management included observation in 6 (46.3%), hydroxyurea in 3 (23.1%), imatinib in 3 (23.1%) and Interferon-α (IFN-α) in 1 (7.7%) patients. Noteworthy obstetric complications encompassed threatened abortion with intrauterine foetal death (IUFD) (1 patient), intrauterine growth retardation (IUGR) (3 patients), oligohydramnios (2 patients), antepartum haemorrhage (1 patient), placental abruption (1 patient), and postpartum haemorrhage (3 patients). At a median follow-up duration of 10.7 years, 11 patients were at a major molecular remission (including 2 patients with deep molecular remission) and two patients progressed to the accelerated phase. The diagnosis and management of CML during pregnancy is a complex and challenging task that requires collaboration between haematologists and obstetricians. Effective management of newly diagnosed CML-CP during pregnancy is contingent on the trimester of presentation. Further research and collaboration are warranted to develop standardised guidelines for managing pregnancy-associated CML, particularly in LMICs.

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妊娠期新诊断慢性髓性白血病的母体和胎儿结局及其长期影响

摘要妊娠期慢性粒细胞白血病（CML）的诊断给血液学专家和产科医生都带来了挑战。在中低收入国家（LMICs），有关妊娠相关慢性粒细胞白血病管理的数据十分有限。本研究旨在评估新诊断为慢性期 CML（CML-CP）的女性患者在妊娠期间的妊娠、胎儿和长期疾病预后。我们对 2002 年 1 月至 2022 年 12 月期间在我院就诊的 CML-CP 女性患者进行了回顾性分析。纳入标准包括妊娠期新诊断出的 CML-CP 患者。通过全面审查医疗记录，分析了与妊娠结局、胎儿发育和疾病进展有关的数据。在女性 CML 患者中，有 13 人在怀孕期间被诊断为 CML-CP。患者年龄中位数为 24 岁（20-35 岁）。六名患者的诊断发生在妊娠前三个月，三名发生在妊娠后三个月，四名发生在妊娠后三个月。结果包括五例选择性终止妊娠（38.5%）、五例早产（38.5%）和三例足月分娩（23.1%）。治疗方法包括观察 6 例（46.3%）、羟基脲 3 例（23.1%）、伊马替尼 3 例（23.1%）和干扰素-α（IFN-α）1 例（7.7%）。值得注意的产科并发症包括胎儿宫内死亡（IUFD）（1 例患者）、胎儿宫内发育迟缓（IUGR）（3 例患者）、羊水过少（2 例患者）、产前出血（1 例患者）、胎盘早剥（1 例患者）和产后出血（3 例患者）。中位随访时间为 10.7 年，其中 11 名患者达到主要分子缓解期（包括 2 名深度分子缓解期患者），2 名患者进展到加速期。妊娠期 CML 的诊断和管理是一项复杂而具有挑战性的任务，需要血液科医生和产科医生通力合作。孕期新诊断出的 CML-CP 的有效管理取决于发病的三个月。有必要开展进一步的研究和合作，以制定管理妊娠相关 CML 的标准化指南，尤其是在低收入国家。

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来源期刊

Indian Journal of Hematology and Blood Transfusion Medicine-Hematology

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期刊介绍： Indian Journal of Hematology and Blood Transfusion is a medium for propagating and exchanging ideas within the medical community. It publishes peer-reviewed articles on a variety of aspects of clinical hematology, laboratory hematology and hemato-oncology. The journal exists to encourage scientific investigation in the study of blood in health and in disease; to promote and foster the exchange and diffusion of knowledge relating to blood and blood-forming tissues; and to provide a forum for discussion of hematological subjects on a national scale. The Journal is the official publication of The Indian Society of Hematology & Blood Transfusion.