Abstracts
PO1
Real-World Data on Clinical Profile, Treatment Strategies, and Feto-Maternal Outcomes of Pregnancies Among Patients with Chronic Myeloid Leukemia in a Resource-Constrained Setting: A 5-year Single-Center Retrospective Cohort Study
Introduction/Background/Significance: Pregnancy in chronic myeloid leukemia (CML) presents a complex clinical challenge due to the necessary interruption of tyrosine kinase inhibitors (TKIs), which may compromise disease control. Although outcomes from high-resource settings are well documented, there is a critical lack of real-world evidence from resource-limited settings, where access to molecular monitoring and pregnancy-compatible therapies is restricted. This gap limits the applicability of current guidelines in routine clinical practice.
Materials and Methods/Case Presentation/Objective: A 5-year retrospective descriptive study was conducted involving pregnant women with CML managed at a tertiary referral center in a resource-limited setting. Clinical characteristics, treatment patterns, and hematologic and molecular responses were assessed at three timepoints: pre-pregnancy, during pregnancy, and postpartum. Maternal and neonatal outcomes were also evaluated.
Results/Description/Main Outcome Measure(s): A total of 26 pregnancies were included, resulting in 27 fetal outcomes (one twin gestation). All patients were in the chronic phase at conception. Prior to pregnancy, 59.1% had achieved MMR or deeper (MMR 18.2%,DMR 40.9%), and 70.0% were in CHR. Majority discontinued TKI after conception (75%), reflecting predominantly unplanned pregnancies. Throughout pregnancy, CHR declined from 70.0% pre-pregnancy to 23.5% by third trimester, and mean WBC count peaked at 95.82 ×10⁹/L in second trimester. Molecular monitoring was performed in only 25% of cases during pregnancy, and among those, only one patient (5.0%) maintained DMR. Management was primarily reactive: 59.1% received no active therapy, 36.3% received hydroxyurea-based regimens, and 4.5% received IFN-α. At follow-up, partial recovery was observed (CHR 50.0%, DMR 35.3%). However, two patients (11.1%) developed blast phase transformation postpartum, including one case with extramedullary CNS involvement. Fetal outcomes were generally favorable, with 85.2% live births, no congenital anomalies, and no maternal mortality. Rates of preterm delivery (45.8%) and low birth weight (25.0%) remained elevated.
Conclusion(s).: In this real-world cohort, pregnancy in CML was associated with favorable fetal outcomes, but maternal disease control was often lost. Unlike in high-resource settings, disease destabilization was primarily driven by system-level issues, including delayed TKI interruption, lack of molecular monitoring, and limited access to pregnancy-safe therapies. These findings challenge notions that current guidelines apply universally and highlight the importance of resource-adapted care, such as simplified monitoring, broader access to interferon, and multidisciplinary reproductive planning. Addressing these gaps and redefining outcomes can promote an equity-focused approach to CML in pregnancy in low-resource settings.
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Materials and Methods/Case Presentation/Objective: A 5-year retrospective descriptive study was conducted involving pregnant women with CML managed at a tertiary referral center in a resource-limited setting. Clinical characteristics, treatment patterns, and hematologic and molecular responses were assessed at three timepoints: pre-pregnancy, during pregnancy, and postpartum. Maternal and neonatal outcomes were also evaluated.
Results/Description/Main Outcome Measure(s): A total of 26 pregnancies were included, resulting in 27 fetal outcomes (one twin gestation). All patients were in the chronic phase at conception. Prior to pregnancy, 59.1% had achieved MMR or deeper (MMR 18.2%,DMR 40.9%), and 70.0% were in CHR. Majority discontinued TKI after conception (75%), reflecting predominantly unplanned pregnancies. Throughout pregnancy, CHR declined from 70.0% pre-pregnancy to 23.5% by third trimester, and mean WBC count peaked at 95.82 ×10⁹/L in second trimester. Molecular monitoring was performed in only 25% of cases during pregnancy, and among those, only one patient (5.0%) maintained DMR. Management was primarily reactive: 59.1% received no active therapy, 36.3% received hydroxyurea-based regimens, and 4.5% received IFN-α. At follow-up, partial recovery was observed (CHR 50.0%, DMR 35.3%). However, two patients (11.1%) developed blast phase transformation postpartum, including one case with extramedullary CNS involvement. Fetal outcomes were generally favorable, with 85.2% live births, no congenital anomalies, and no maternal mortality. Rates of preterm delivery (45.8%) and low birth weight (25.0%) remained elevated.
Conclusion(s).: In this real-world cohort, pregnancy in CML was associated with favorable fetal outcomes, but maternal disease control was often lost. Unlike in high-resource settings, disease destabilization was primarily driven by system-level issues, including delayed TKI interruption, lack of molecular monitoring, and limited access to pregnancy-safe therapies. These findings challenge notions that current guidelines apply universally and highlight the importance of resource-adapted care, such as simplified monitoring, broader access to interferon, and multidisciplinary reproductive planning. Addressing these gaps and redefining outcomes can promote an equity-focused approach to CML in pregnancy in low-resource settings.
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