Introduction Chronic myeloid leukaemia (CML) is defined by the presence of the BCR::ABL1 oncogene, resulting from a translocation between chromosomes 9 and 22. This translocation, fuses parts of the BCR and ABL1 genes, creating a chimeric protein that drives uncontrolled proliferation of white blood cells (WBC). Advances in the treatment of CML with tyrosine kinase inhibitors (TKIs) have transformed the course and prognosis of the disease. Although CML is predominantly a disease of the elderly, cases are seen in young people. Therefore, women with CML of childbearing age and receiving TKIs could become pregnant during treatment. TKIs are teratogenic.

Objectives To determine the incidence of pregnancies in patients with CML receiving TKIs as well as their management and outcomes

Material and Methods A retrospective, cross-sectional, single-center study was conducted. The medical records of patients with CML and pregnancy were included from June 2004 to July 2025. The variables were age, disease´s phase, WBC, Sokal index, molecular response, prior exposure to TKIs, and exposure to TKIs during pregnancy.

Results We treated 334 patients with CML. Of these, 142 patients (43%) were women, of whom 57 (17%) were of childbearing age. Nineteen cases of unplanned pregnancies were recorded while receiving TKIs: fifteen on imatinib and four on dasatinib. In all cases, the TKI was discontinued upon confirmation of pregnancy. In three patients the TKI was restarted at week 21 of pregnancy. Follow-up was monthly, with periodic monitoring of molecular response. The median age was 29 years; all patients were in chronic phase. Five pregnancies ended in spontaneous abortion, thirteen completed the pregnancy with healthy offspring, and one cases have not yet reached term. One patient had two pregnancies, one miscarriage and one successful pregnancy, and another patient had two successful pregnancies. Five patients had WBC counts above 20,000/mm³, 11 patients (58%) with an intermediate Sokal index. No cases of blast crisis were recorded.

Conclusion Our CML patients have a younger median age than reported in other series. Therefore, they are exposed to TKIs for longer periods, and pregnancies in young women are not uncommon. Management should be individualized, beginning with discontinuation of TKIs and close follow-up. Management strould be more aggressive. The duration of prior TKI exposure and exposure during pregnancy may be the most determining factors for a successful delivery

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2025
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