Managing CML in Pregnancy When Initial Count Control Has Not Been Maintained

Clinical Scenario

Female patient, pregnant, with chronic myeloid leukemia in chronic phase. Rarely, women with CML present in pregnancy, placing gestational timing at the centre of every treatment decision.

When the First-Line Approach Has Not Been Sufficient

Up to gestational week 16, the initial strategy — TKI discontinuation at confirmation of pregnancy, with options including interferon-alpha, leucapheresis, or watchful waiting — aims to keep white cell count below 100 ×10⁹/L and maintain complete hematologic response. When this count threshold or hematologic response cannot be sustained, escalation to the next treatment step is indicated.

Next-Step Treatment Approach

After gestational week 16, the protocol introduces targeted oral therapy directed at restoring count control and maintaining complete hematologic response. For certain patients, additional supportive measures may also be considered. The full criteria, options, and sequencing are defined in the structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

Rarely women with CML present in pregnancy.
If RT-qPCR is increasing rapidly and/or loss of CHR and after week 16, start imatinib 400 mg daily. Nilotinib up to 400 mg daily can be used in case of imatinib resistance or intolerance.
Consider acetylsalicylic acid and/or low molecular weight heparin for patients with thrombocytosis.

DOI: 10.1038/s41375-025-02664-w

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