慢性髓性白血病患者的生育和疾病结局

OBJECTIVE: To explore Fertility and disease outcomes in patients with chronic myeloid leukemia（CML）. METHODS: Clinical and fertility outcomes of male（from Jul. 1998 to Feb. 2018）and female CML（from Sep. 2009 to Feb. 2018）patients were retrospectively analyzed at Peking University People's Hospital. RESULTS: A total of 49 male CML patients and their spouses were enrolled. Before their spouses conceived, 34 patients were receiving tyrosine kinase inhibitor（TKI）imatinib, 9 with nilotinib, and 6 with dasatinib. At the time of conception, the median age of these male patients was 32 years（range, 25-48 years）, and the median TKI treatment duration was 36 months（range, 0.2-198 months）. One male patient having achieved complete hematologic response yet discontinuing TKI for a year developed a disease progression to blast crisis. The other 48 patients sustained stable disease. The total conception times were 61 and finally 55 infants were born including one with premature birth, two with low birth weight, and one with hypospadias receiving surgery. The other 18 female patients after pregnancy were enrolled. Two patients developed spontaneous abortions. Two received induced abortions. Fourteen gave birth to healthy infants without congenital malformation. The interval from diagnosis of CML to initiation of TKI was 4 months（range, 0.3-16 months）. During a median follow-up of 45 months（range from 7-114 months）, the estimated complete cytogenetic response（CCyR）rate, major molecular response（MMR）rate and molecular response(4.5)（MR(4.5)）rate by 5 years were 88.9％, 85.3％ and 35.1％, respectively. The estimated failure-free survival, progression-free survival and overall survival were 64.2％, 90.9％ and 90.9％, respectively. All 14 babies developed as normal. CONCLUSION: It seems that TKIs do not affect pregnancy outcome in the spouses of male CML patients, suggesting that withdrawal of TKIs is not necessary. Female CML patients have good pregnancy and disease outcomes in the TKI era.