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Pregnancy and interferon

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Hi all

I am 31 years old and finally pregnant after being diagnosed with cml 4 years ago and waiting so long for this moment. I went in to remission last year and came off my Dasatinib in April this year, unfortunately the cancer came back and at the same time I got pregnant so I was on imatinib 100mg then 200mg for the first 4 weeks of pregnancy and have since stopped. I am currently 10 and a half week pregnant and every time my bloods are done my white blood cells are getting higher. My haematologist is advising I start interferon injections by my second trimester. Can anyone who has had the injections during pregnancy tell me how it was for them? I am extremely overwhelmed by this news and am scared of what could happen. Any advice would be so helpful. Thank you!

Hi Misbah,

Interferon is sometimes given in pregnancy when numbers start to rise. There are a couple of types of interferon, and side effects are different. Pegylated interferon is tolerated better.

I guess for you the good news is we know lots more about CML and pregnancy than we did even just a few years ago. The time when imatinib is dangerous for the baby is in quite a specific few weeks of the pregnancy, so it's not at all unheard of to resume imatinib later in the pregnancy if the numbers increase sufficiently.

Can I ask where you are treated?

Here's a couple of videos you should watch:

From CML Horizons in 2025, Ekaterina Chelysheva discusses CML and pregnancy.
https://vimeo.com/1089549501

This from from CML Horizons in 2022 and I think it a bit easier to understand. It's from Prof Jane Apperley from London.
https://vimeo.com/778953440

Your doctor can get in touch with the expert team at Hammersmith Hospital to discuss the best approach. If your doctor is not a real expert in CML and pregnancy then this really would help.

https://cmlsupport.org.uk/asktheexpert

David.

Misbah,

If you are comfortable reading more technical literature, there was a paper published just a few months ago about managing CML and pregnancy,

https://www.cml-foundation.org/news3/2401-how-i-manage-chronic-myeloid-l...

The key points are:

- TKIs should be stopped at the first positive pregnancy test to avoid teratogenic exposure during weeks 5–10.
- IFN-α is the preferred therapy at any gestational age; hydroxyurea may be used only briefly for uncontrolled hyperleukocytosis if leukapheresis is unavailable.
- Imatinib and nilotinib can be considered after 16 weeks; dasatinib must be avoided due to high placental crossing and fetal toxicity.
- Treatment strategy depends heavily on initial response status: women in stable deep molecular response (DMR) have the best chance of remaining untreated during pregnancy.
- Rapid rises in BCR::ABL1 transcripts (>1–10%) or loss of complete hematologic remission (CHR) warrant reinitiating therapy.
- Breastfeeding is not recommended with TKIs; could be considered if on IFN.

David.