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Imatinib use during pregnancy and breast feeding: a case report and review of the literature

Archives of Gynecology and Obstetrics volume 280, pages 169–175 (2009)Cite this article

Abstract

Introduction

The development of imatinib as a therapeutic agent targeting BCR-ABL has increased the treatment options for chronic myeloid leukemia (CML) by significantly impacting outcomes, and imatinib is recommended by treatment guidelines as the first-line therapy. However, treatment of maternal CML with imatinib during gestation is not recommended because of the potential risk to the fetus.

Materials and methods

We describe the clinical presentation, course and outcome of one pregnant patient with CML who was treated with imatinib. We review all pregnancies associated with imatinib documented in the literature.

Case presentation

A 27-year-old pregnant patient was diagnosed to have Philadelphia chromosome positive chronic phase CML in August 2007. Imatinib was administered (400 mg/day) between the 21st and 39th weeks of gestation. The patient tolerated the drug well and achieved complete hematological and cytogenetic remission. There were no imatinib-related maternal complications during the pregnancy. Fetal growth remained normal as well as amniotic fluid volume estimation. Labor was induced at the 39th gestational week, resulting in the uneventful vaginal delivery of a healthy male infant without any congenital anomaly. Umbilical cord blood and infant peripheral blood were collected at delivery. No postnatal complications occurred; however, imatinib was present in the umbilical cord blood (338 ng/mL) and in the infant’s peripheral blood (478 ng/mL). Breast milk was collected on different postpartum days, and concentrations of imatinib were detected. At 10 months of age, the baby had normal growth and development.

Conclusions

In light of reported cases and our experience, treatment of CML during the second and third trimesters of gestation and breast feeding seems to be safe, but the data are still limited and the effects of chronic exposure of infants to imatinib are not known. We think that each case should be examined and considered independently, and decisions should be individualized.

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Acknowledgments

We thank Dr. Murat Oktem (Duzen Research Laboratory, Ankara, Turkey) for the analyses of samples used in this study and Dr. Kemal Erguder (Novartis Pharmaceuticals, Izmir, Turkey) for collaboration. Duzen Research Laboratory is supported by a grant from Novartis Pharmaceutical Corporation.

Conflict of interest statement

Authors declare no potential financial disclosure or conflicts of interest.

Author information

Affiliations

  1. Division of Hematology, Department of Internal Medicine, Uludag University School of Medicine, Gorukle, 16059, Bursa, Turkey

    Ridvan Ali, Fahir Ozkalemkas, Vildan Ozkocaman, Hakan Yorulmaz & Ahmet Tunali

  2. Department of Obstetrics and Gynecology, Uludag University School of Medicine, Bursa, Turkey

    Yalcin Kimya

  3. Division of Neonatology, Department of Pediatrics, Uludag University School of Medicine, Bursa, Turkey

    Nilgun Koksal

  4. Department of Genetics, Uludag University School of Medicine, Bursa, Turkey

    Tuna Gulten

Authors
  1. Ridvan Ali
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  2. Fahir Ozkalemkas
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  3. Yalcin Kimya
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  7. Hakan Yorulmaz
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Correspondence to Ridvan Ali.

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Ali, R., Ozkalemkas, F., Kimya, Y. et al. Imatinib use during pregnancy and breast feeding: a case report and review of the literature. Arch Gynecol Obstet 280, 169–175 (2009). https://doi.org/10.1007/s00404-008-0861-7

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  • DOI: https://doi.org/10.1007/s00404-008-0861-7

Keywords

  • Imatinib
  • Chronic myeloid leukemia
  • CML
  • Cancer
  • Pregnancy
  • Breast milk
  • Umbilical cord blood
  • Infant peripheral blood
  • Targeted therapy