Successful ovarian stimulation and pregnancy in an infertile woman with chronic myeloid leukemia
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FERTILITY PRESERVATION
Successful ovarian stimulation and pregnancy in an infertile woman with chronic myeloid leukemia Silvina J. Rios 1 & Lorena Martínez-Montesinos 1 & Cristina Aroca 1 & Raul Teruel-Montoya 1,2,3 & Francisca Ferrer-Marín 1,2,3 Received: 21 May 2020 / Accepted: 28 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Chronic myeloid leukemia . Pregnancy . In vitro fertilization . Imatinib . Fertility . TKI
Introduction In the last decade, tyrosine kinase inhibitors (TKI) treatment has transformed chronic myeloid leukemia (CML) from a fatal neoplasm into a chronic disease with normal life expectancies. Importantly, although the median age of CML onset is 65 years, up to 25–37% of patients are in reproductive age at the time of diagnosis [1]. While there is a consensus that TKI are strongly
* Francisca Ferrer-Marín [email protected] 1
Hematology and Medical Oncology Unit, Hospital Morales-Meseguer, Centro Regional de Hemodonación, IMIB-Arrixaca, UCAM, C/Ronda de Garay, 30003 Murcia, SN, Spain
2
CIBERER (U/765), Murcia, Spain
3
Grado de Medicina, UCAM, Murcia, Spain
discouraged at the time of conception and during the pregnancy due to the risk of fetal abnormalities and miscarriage [2, 3], the information on the effects of imatinib and other TKI on fertility is still limited
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