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Pregnancy with CML

Hello I have CML. I've had it for a few years now. I've been in remission for over a year. I was told to not get pregnant while taking it. I just found out that I am pregnant and after reading the testimonials of people having successful pregnancies. I see that there is a possibility of me having one. What steps should I take? Get a second opinion? See what my options are besides aborting the baby?

Hi there, 

It's certainly a complicated situation, and many things depend on the individual. It would really help if you could go into a bit more detail on a few things:

  • When were you diagnosed?
  • Where are you being treated? (just the country is fine)
  • What medication are you on (imatinib / dasatinib etc), and what dose?
  • What is your most recent PCR test result? You said you have been in remission for a year - do you mean below 0.1%?

I'd urge you to read this presentation, if you are at all "sciencey".

Apperley - CML & Pregnancy - CML Advocates Network

The long story made short is that the ability to continue a pregnancy and successfully have a baby depends on many things. TKIs are not a good mix with pregnancy, so you need to get in touch with your doctor as soon as you can no matter what.

In some cases, where the mother has been on treatment for a while and has responded well, it's possible to stop taking the TKIs and instead take interferon. Interferon is not as effective against CML than a TKI, but it's better than nothing and doesn't harm the foetus. In some cases it can stop the CML returning, or returning to an unsafe level, while allowing the pregnancy to continue and then some time after delivery the TKI is restarted. You would be extra-closely monitored both from an obstetrical point of view and also a CML point of view. Of course this isn't always possible, and sometimes very hard decisions have to be made.

David.

Hi David I was diagnosed in 2012 in the US. I didn't consistently take Gleevec(400) in the beginning but now I do. And I'm not sure about my levels. But my hemotologist said that I was doing really well. I will look at your video

2012 is a fair while ago, so presuming you are doing very well now there's every reason to be hopeful that you could successfully have the baby. Consistency of taking your medication is really important, so I hope you've been doing that for a long time now.

But you do need to get in touch with your doctor ASAP to discuss it, and don't wait for your next routine appointment. Find out your PCR results history from them and get it printed out by them - this is very important if you need a second opinion. 

If your doctor says you should not have the baby, you should get a second opinion. Since you have been on treatment for a good long time now, and assuming you want the baby, there's a reasonable chance that it ought to be possible.

David.