Patient Care of Pregnant Women With Chronic Myeloid Leukemia in a Resource Limited Setting-Case Reports From Ghana.
This report describes three Ghanaian women with CML who stopped imatinib after pregnancy confirmation, underwent monthly blood-count monitoring, and, among the two retained in follow-up, delivered without reported adverse events or fetal abnormalities and restarted imatinib within six months.
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This report describes three Ghanaian women with CML who stopped imatinib after pregnancy confirmation, underwent monthly blood-count monitoring, and, among the two retained in follow-up, delivered without reported adverse events or fetal abnormalities and restarted imatinib within six months.
Research significance
The cases provide limited evidence that coordinated TKI interruption, pragmatic monitoring, and postpartum treatment resumption can be feasible for selected pregnant patients with CML in a resource-limited setting; it remains an inference, not an established safety finding, that the proposed framework improves maternal or fetal outcomes.
Source abstract
Although life expectancy and survival have improved for CML patients due to the advent of tyrosine kinase inhibitor (TKI) therapies, the quality of life and family planning for women still hold challenges, especially in a resource-limited setting where routine molecular monitoring and pregnancy-compatible therapeutic options are limited. Due to their teratogenicity, TKI therapies are generally considered to be contraindicated during pregnancy. Here, we present case reports of three patients from the Korle-Bu Teaching Hospital in Accra, Ghana, who were diagnosed with CML prior to pregnancy. A 29-year-old, 19-year-old and 33-year-old female were diagnosed with CML at the clinic. All patients initiated imatinib, which was stopped after confirming pregnancy. Patients were subsequently monitored with a monthly full blood count (FBC). While one of the patients was lost to follow-up, the other two patients delivered without adverse events or fetal abnormalities and were able to restart imatinib therapy within 6 months. Based on the presented cases, a pragmatic framework emerges: (1) embed comprehensive counselling at diagnosis; (2) encourage planned conception only after sustained molecular remission; (3) stop TKIs upon pregnancy confirmation; (4) monitor with clear, communicated thresholds for intervention; (5) introduce cytoreduction after the first trimester only when clinically indicated and consent given; and (6) align postpartum feeding plans with timely TKI re-initiation. As a conclusion, in contexts where social pressure to bear children is strong and pregnancy-safe treatments are limited, transparent counselling, a remission-first strategy, and tightly coordinated hematology-obstetric care offer the best path to balancing reproductive autonomy with maternal and fetal safety.