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Outcome of imatinib mesylate in women with child-bearing age diagnosed with chronic myeloid leukemia

BACKGROUND: Imatinib Mesylate (IM) is an oral tyrosine kinase inhibitor, which demonstrates great effect in the treatment of both chronic myeloid leukemia (CML) and gastrointestinal stromal tumors. The effects of this chemotherapeutic drug on women with child bearing age, fertility, and reproductive system have been reported in some studies as case series; therefore, this study was designed to demonstrate the outcome of imatinib on females with child-bearing age. PATIENTS AND METHODS: This is a prospective cross-sectional study conducted in the National Center of Hematology/Mustansiriyah University in Baghdad. The study started on February 2018 and was ended in July 2020. It included 55 female patients. A questionnaire was designed to elicit the effects of imatinib mesylate on fertility and outcome of pregnancies. RESULTS: Out of 55 women diagnosed with CML in chronic phase, 13 patients were able to conceive during the study. All of them were treated with imatinib mesylate 400 mg per day before pregnancy. All of them were at least in complete cytogenetic response. Four (30.7%) pregnant patients continued treatment throughout pregnancy with uneventful pregnancy and delivery, without any congenital anomalies. other 4 (30.7%) pregnant patients received IM during 1st and 2nd trimester only and then discontinued treatment with IM. Five (38.4%) pregnant patients who received IM during 1st trimester ended with abortion (either elective or missed abortion). CONCLUSION: Treatment of CML with IM during the pregnancy has different perspectives and the data are still limited. Hence, each case decision should be individualized balancing the risk to the fetus of continuing IM versus the risk to the mother of interrupting treatment.