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Home Cancer Leukemia Chronic Myeloid Leukemia in Pregnancy

Chronic Myeloid Leukemia in Pregnancy

From time to time a woman is found to have Chronic Myeloid Leukemia as a result of a routine blood test performed early in pregnancy. It is probable that without the test the disease would not have been diagnosed for some months or even a year later. However, the finding of chronic myeloid leukemia is not a reason for terminating the pregnancy because there is no suggestion that pregnancy makes chronic myeloid leukemia any worse. Whether the pregnancy continues, becomes a matter for discussion between the patient and her partner.

In general, if the woman wanted the child originally, the pregnancy should continue as normally as possible and the delivery should be quite straight–forward. Anti–Leukemic drugs must however be avoided until the baby is delivered. This is usually fairly easy to achieve in the patient who had no symptoms when first diagnosed.

Drugs used in treatment
Interferon
Interferon is a substance produced naturally by the body in response to virus infections. Interferon can be synthetically prepared has been found to be effective against some forms of leukemia.

Interferon is given by injection into the skin (Subcutaneously) on several days each week. It may be combined with Hydroxyurea treatment or with another drug, given by injection, called Cytosine Arabinoside. In about a quarter of patients interferon may very greatly reduce the number of leukemia cells in the bone marrow. The side effects are similar to a very severe bout of flu. Most patients can control the side–effects with Paracetamol but some will have to stop taking the drug.

Hydroxyurea
Hydroxyurea is now generally used for treating chronic myeloid leukemia. The drug is given in tablet form on a daily basis. It does not interfere with male or female fertility. It is, however, still necessary to avoid pregnancy while taking the drug because Hydroxyurea can cause damage to the baby.

The disadvantage of Hydroxyurea is that, it must be taken daily otherwise the white cell count rises rapidly if the drug is stopped, At high dosage Hydroxyurea may cause upset stomach, mild nausea and perhaps some diarrhea.

Busulphan
Busulphan was used to treat chronic myeloid leukemia in the 1970’s and still has a valuable role to play, although it is now used less frequently than hydroxyurea. Busulphan rapidly restores the leukocyte count to normal and the patient soon feels much better. The spleen also gets smaller. Busulphan can, however, damage the bone marrow so the patient’s blood count must be carefully checked every few weeks. Busulphan may be given as pills daily or as a larger dose once a month or less often.

In women of child–bearing age busulphan causes abnormal menses. This is because the drug directly affects the ovaries. Women may thus develop symptoms of an early menopause, especially hot flushes. These symptoms can easily be prevented by taking a small dose of hormone replacement but the patient must tell her doctor about them. A woman who has started taking busulphan is unlikely to get pregnant so contraception is probably not needed once the periods have stopped.

Busulphan has a similar effect on men. It affects sperm production. A man who has been taking busulphan for months may no longer be able to father a child although libido (interest in sex) and sexual potency are unaffected.

A man should certainly consider asking his doctor to arrange storage of some of his sperm cells if he is considering having children in the future.

Busulphan has another side effect that may become apparent after some years. Patients’ skin may become pigmented such that they look as if they are deeply tanned.

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