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Successful ovarian stimulation and pregnancy in an infertile woman with chronic myeloid leukemia

  • Fertility Preservation
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Abstract

Background

Tyrosine kinase inhibitors (TKI) treatment has transformed chronic myeloid leukemia (CML) from a fatal neoplasm to a chronic disease with normal life expectancies. Indeed, half of CML patients are able to discontinue TKI without relapse. However, it seems clearly demonstrated that exposure to TKI may result in fetal malformations. Regarding its effects on fertility, preclinical studies and clinical case reports provide inconclusive evidence. Furthermore, due to the risk of CML relapse after TKI discontinuation, the optimal time to stop TKI represents a real dilemma.

Case report

We describe a 23-year-old woman who, after more than 6 years with imatinib and 1 year in deep molecular response [(DMR), MR ≥ 4], interrupted treatment to become pregnant. After 2 failed artificial insemination cycles, she underwent one process of controlled ovarian stimulation, achieving 2 blastocyst-embryos. In the meantime, BCR-ABL1IS levels increased despite interferon-alpha therapy, she lost the mayor molecular response (MMR), and the 2 embryos had to be cryopreserved. A stable second MR ≥ 4.0 was again obtained with nilotinib, and after stopping it, the 2 blastocyst-embryo transfers were unsuccessfully performed. Under DMR, a second ovarian stimulation and in vitro fertilization (IVF) was performed and 1 blastocyst embryo was transferred. This time, she became pregnant and a healthy baby was born. After more than 3 years of follow-up, she remains in treatment-free remission (TFR).

Conclusion

Compared with imatinib, nilotinib achieves earlier and deeper MR that allows safe and timely pregnancies in infertile CML women through IVF process, while patients remain in TFR after delivery.

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Acknowledgments

This work was supported by the Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER): Grant no. PI18/0316 for FFM and 20644/JLI/18 for RTM. The authors thank Jose Eliseo Blanco (Deparment of Obstetrics and Gynecology, IMIB-Arrixaca, Murcia, Spain) for his critical review of the paper.

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Authors and Affiliations

  1. Hematology and Medical Oncology Unit, Hospital Morales-Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, UCAM, C/Ronda de Garay, 30003, Murcia, SN, Spain

    Silvina J. Rios, Lorena Martínez-Montesinos, Cristina Aroca, Raul Teruel-Montoya & Francisca Ferrer-Marín

  2. CIBERER (U/765), Murcia, Spain

    Raul Teruel-Montoya & Francisca Ferrer-Marín

  3. Grado de Medicina, UCAM, Murcia, Spain

    Raul Teruel-Montoya & Francisca Ferrer-Marín

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  1. Silvina J. Rios
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  2. Lorena Martínez-Montesinos
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  4. Raul Teruel-Montoya
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Correspondence to Francisca Ferrer-Marín.

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Rios, S.J., Martínez-Montesinos, L., Aroca, C. et al. Successful ovarian stimulation and pregnancy in an infertile woman with chronic myeloid leukemia. J Assist Reprod Genet 37, 2473–2476 (2020). https://doi.org/10.1007/s10815-020-01907-2

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  • DOI: https://doi.org/10.1007/s10815-020-01907-2

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