Treatment guidelines for children and pregnant women with chronic myeloid leukemia

This article reviewed the NCCN guidelines for the treatment of chronic myeloid leukemia in children and in pregnant women.

The majority of CML patients are diagnosed when older (an average age of 65). Roughly 36.5% of patients are younger, and are diagnosed at reproductive age or in childhood. It is important to consider the long-term health of the patient when determining the best treatment options. A panel of experts have provided recommendations for the treatment of children and pregnant women with CML.

This article outlined the NCCN (National Comprehensive Cancer Network) guidelines for the treatment of CML in childhood and pregnancy.

Before trying to conceive, it is recommended that women discuss the issue with their doctor. Pregnancy while using tyrosine kinase inhibitor (TKI) therapy (such as imatinib) is discouraged. TKI treatment during pregnancy increases the risk of miscarriage (reported at 10%-17% in different studies) and fetal abnormalities (10%-15%). TKI treatment of the father does not appear to increase the risks of problems.

It is recommended that women stop TKI therapy before conceiving. Studies have shown that TKI therapy can be safely stopped in patients who have had long-term complete molecular responses (disappearance of the BCR-ABL gene involved in the development of CML). Two small studies have examined this in pregnancy. Based on the results, it is estimated that a woman has a 60% chance of disease progression if she had reached a complete molecular response. The risk is higher if she had not. It is not clear how long before conception a TKI should be stopped. It can be restarted after delivery, but women should not breastfeed. Women should be monitored during pregnancy for any sign of disease progression. Other treatments, such as interferon and hydroxyurea, are considered safe during pregnancy.

There are no evidence-based recommendations for the treatment of CML in children. The TKI imatinib (Gleevac) is the only TKI that is FDA approved as a first-line treatment for children. One study noted that imatinib led to a complete hematologic response (no symptoms of CML, with normal blood counts) in 98% of patients. 98% were progression free at 36 months. Higher doses of imatinib (340 mg/m2) led to a molecular response in 66.6% at 12 months.

Children treated with TKI inhibitors should be monitored for growth abnormalities. Stopping TKI treatment is not recommended. Live vaccines (such as the yearly flu nasal spray) should not be used. Inactive, killed vaccines should be given instead.

This study reviewed the recent NCCN guidelines for the treatment of CML during childhood and pregnancy.