Treatment of Chronic Myeloid Leukemia in Pregnancy (Chronic Phase)

Occasionally, women living with chronic myeloid leukemia in chronic phase discover they are pregnant. This uncommon clinical scenario requires a careful reassessment of ongoing therapy and blood count management to balance maternal disease control with foetal safety.

Clinical scenario

A female patient with chronic myeloid leukemia in chronic phase who is pregnant. Managing CML during pregnancy is clinically challenging because standard maintenance therapy must be reconsidered immediately at confirmation of pregnancy.

Treatment goals

The primary objectives are control of the white cell count and maintenance of complete hematologic response throughout the pregnancy, while minimising foetal exposure to potentially harmful agents.

Approach (partial overview)

Management begins with an immediate change to ongoing targeted therapy at the point pregnancy is confirmed. Subsequent count control — where needed — may involve biological or procedural interventions depending on the patient's symptom burden and white cell count level. Some patients may be candidates for a period of close observation rather than immediate active intervention.

The full structured protocol — including specific agents, sequencing, and criteria for escalation — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1038/s41375-025-02664-w

Rarely women with CML present in pregnancy.

Discontinue the TKI at confirmation of pregnancy.

IFN, including pegylated forms, can be used safely during pregnancy and can be given for count control, recognizing that IFN is slow acting.

Leucapheresis alone—will depend on service availability and intravenous access.

Leucapheresis in combination with IFN.

Data from Robertson et al. reported that intervention by leucapheresis, IFN or both, was more likely in women presenting with high white cell counts (WCC) leading to the suggestion that patients with WCC < 100 × 10⁹/L can be initially managed by a period of watchful waiting to assess the count dynamics before introducing therapy.

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