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Pregnant while taking Glivec and scared!!

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Scared! 

 

Ive been on Glivec for 4 months and doing really well! But I've recently discovered after one silly night that I've become pregnant and I didn't realise for 2-3 weeks, I'm praying that my baby hasn't been affected and I've literally only just found out his morning about the pregnancy so really would like some opinions and support. The doctor keeps pushing me for an abortion but there is no way on earth I'm giving up on this baby, I'm so so scared about myself and the baby's health but I can't bring myself to an abortion. Has anyone been through this? I want to go through with this so much but I'm scared, I'm 20 years old too do my first child! 

Hi!

Pregnancy and TKIs together certainly is complicated, but it's not an in surmountable problem for everyone.

How long have you had CML for, and what was your latest PCR result? It's really important to know your PCR. For some, with a low enough PCR there are avenues to explore around discontinuing your TKI whilst pregnant - but it's not suitable for everyone.

David. 

Hi thankyou so much for replying. It was at 8% last month and I've had CML for 5 months now. The doctors over whelming me with the risks and so scared for me and the baby but I know that I'm not terminating it. 

Hi again,

While 8% at 5 months is nothing to worry about from a treatment response point of view for you, it's too high to stop taking TKIs for the length of a pregnancy I think. I was hoping you were going to say you have had CML for several years and had a very low PCR.

Most recommendations would centre around needing to have been in MMR (0.1% PCR) for 24 months before becoming pregnant - this allows a safer management of CML without taking TKIs during pregnancy.

Here is a presentation from Prof Jane Apperley which discusses some of the issues with CML and pregnancy.

http://www.cmladvocates.net/download/cml-horizons-conferences/cml-horizons-2013/presentations/335-apperley-cml-a-pregnancy/file

They key statistics presented are:

Out of 125 monitored pregnancies, >70%received imatinib in first trimester only and 26% received imiatinib throughout pregnancy. Of them:

  • 50% normal live infant
  • 28% elective termination
  • 9.6% foetal abnormality
  • 14.4% spontaneous abortion

Unfortunately this presentation doesn't break down between those that took imatinib for the whole pregnancy and those who did not.

It's a very precarious decision for you. Assuming you are steadfast and elect not to terminate your pregnancy, no matter what you do it's a pretty big gamble: either with your own health, or that of the baby bearing in mind that the foetal abnormalities referred to above are very serious. If you do decide to go ahead with the pregnancy, your CML will have to be monitored very closely. As I understand it, the most precarious time is during organogenesis (when the organs in the foetus are developing) - i.e. in the first three months, so it's really important you get the right treatment plan in place ASAP if you are staying with the pregnancy.

Would you find it useful to get a second opinion from another CML specialist? Your doctor has your health foremost in their mind, but sometimes it's good to hear from another person even if what they say is exactly the same as it may reinforce the reasoning behind their opinion in you mind.

PS: here is a thread from this board which has a very happy ending ... but be aware that not every story with imatinib and pregnancy is happy.

http://www.cmlsupport.org.uk/thread/10119/cml-pregnancy

David.

Hi Jadey, I have little to add other than to say I agree absolutely with all David has said. There are risks, and some potential large ones for you both, but the rewards can be great, as many have shown, but it is still very early days in your treatment.

I am sure you will make the right decision for yourself, with the help of Doctors, and family. A second option would be good, perhaps from a Dr that has dealt with a few CML pregnancies. All the best.

 

Hi Jadey, 

I agree with everything that has been said... the danger with taking imatinib and pregnancy seems to be within the first trimester (3 months) which David has already pointed out. It is quite hard for Doctors to advise you on this as there is a definite risk of TKIs causing foetal abnormalities (within the first developmental stage) even though from what you say the exposure has only been very short .... so it is not surprising your doctor is pro termination of this pregnancy.

I assume you have already stopped taking imatinib as you say you are determined to go forward with your pregnancy? I would also suggest that you try to get a second opinion if possible. Professor Jane Apperley at Hammersmith Hospital has a particular interest in TKI therapy and pregnancy. Your doctor could arrange for you to see her if you ask. 

No one can really force you to do anything you do not wan to do but, you do need to seek out all the facts and get as much expert advice as possible so you can make a fully informed decision about the risk in your case.

Sandy