Imatinib/interferon-alpha
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Various toxicites: case report A female patient is second decade of life [exact age at onset not stated] developed gastrointestinal toxicity, weight gain, periorbital oedema and haemorrhagic corpus lutem during treatment with imatinib. She developed neutropenia during treatment with interferon-alpha [routes, time to reactions onsets and outcomes not stated]. The female patient was diagnosed with chronic myeloid leukaemia (CML) in September 2007. Subsequently, she started receiving imatinib 400 mg/day and achieved a quick haematological response. During the imatinib therapy, she developed periorbital oedema, grade 1 gastrointestinal toxicity and weight gain. She achieved a complete cytogenetic response after 6 months from the initiation of imatinib therapy. However, during the further follow-up, the imatinib treatment showed a suboptimal response to CML. Hence, the dose of imatinib was increased to 600 mg/day from June 2011. She achieved a stable mayor molecular response (MMR) and deep molecular response (DMR) with an elevated dose of imatinib. However, she experienced three haemorrhagic corpus lutem in October 2011, November 2011 and June 2012, respectively. She started receiving oral contraceptives from July 2012. She achieved stable MMR for 2 years and DMR for 16 months with the imatinib therapy. However, due to her desire for pregnancy, the treatment with imatinib and oral contraceptives were discontinued in January 2014. However, after 4 months, she lost MMR. Therefore, she started receiving interferon-alpha at the dose of 4.5 × 106 UI/48 hours without toxicity. She received two artificial insemination processes with the husband’s semen, as she did not get pregnant. However, these artificial insemination processes were unsuccessful. At the same time, despite interferon-alpha therapy, she lost the MMR. Therefore, the dose of interferon-alpha increased up to 4.5 × 106 UI/day and ovarian stimulation was planned. Subsequently, she underwent controlled ovarian stimulation with recombinant FSH treatment (Follitropin-alfa) and GnRH antagonist. At the same time, she developed grade 3 neutropenia secondary to the high dose of interferon-alpha. Hence, the female patient’s interferon-alpha was discontinued on 29 June 2015. Due to neutropenia and loss of DMR, the procedure of embryo transfer was postponed. On 09 July 2015, she started receiving nilotinib to achieve DMR. She achieved DMR with nilotinib therapy. After 14 months in DMR, in November 2016, nilotinib was discontinued. Thereafter, the 2 blastocyst-embryo transfers were unsuccessfully performed. Hence, second ovarian stimulation and in vitro fertilization (IVF) was performed. Following the second ovarian stimulation and IVF treatment, she became pregnant and eventually delivered a healthy baby girl. After more than 3 years of follow-up, she remains in treatment-free remission (TFR). Rios SJ, et al. Successful ovarian stimulation and pregnancy in an infertile woman with chronic myeloid leukemia. Journal of Assisted Reproduction and Genetics 37: 803520558 2473-
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