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CML and Pregnancy — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyCML and PregnancySCE Medical Oncology

A 45-year-old woman with CML achieves deep molecular response on imatinib. She wishes to become pregnant. What is the recommended approach?

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Correct answer: D — Discontinue imatinib before conception (planned TKI cessation with molecular monitoring); TKIs are teratogenic and must be stopped during pregnancy

All approved TKIs (imatinib, dasatinib, nilotinib, bosutinib, ponatinib) are teratogenic and must be discontinued before conception. For women in sustained deep molecular response (MR4.0+ for ≥2 years), planned TKI cessation can be attempted with monthly molecular monitoring. If molecular response is lost, TKI should be restarted (and pregnancy deferred). Interferon-alpha is the only safe systemic agent during pregnancy if treatment is needed. Close collaboration between haematology and obstetrics is essential.

Reference: ESMO 2024 CML Guidelines; ELN CML Guidelines; NICE TA251