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.