Breastfeeding in patients with chronic myeloid leukaemia: case series with measurements of drug concentrations in maternal milk and review of literature
Main Article Content
Keywords
chronic myeloid leukaemia, pregnancy, breastfeeding, milk, breast milk, imatinib, nilotinib, dasatinib, molecular response
Abstract
Breastfeeding in patients with chronic myeloid leukaemia (CML) who take tyrosine kinase inhibitors (TKIs) is not recommended but interruption of TKI treatment may cause the loss of remission. We observed the kinetics of the leukaemic clone in 3 women with CML in accordance with treatment interruptions for pregnancy and breastfeeding. The concentrations of nilotinib and imatinib in maternal milk were measured when the breastfeeding period was over. Nilotinib transfer into human breast milk was demonstrated for the first time and had a maximum concentration (Cmax) 129 ng/ml after 4 hours of the drug intake at a dose of 400 mg. The Cmax of imatinib in maternal milk ranged from 420 to 1411 ng/ml after 4-8 hours of the drug intake at a dose of 400-600 mg. Breastfeeding without TKI treatment may be safe with molecular monitoring, but preferably in those patients with CML who have durable deep molecular response.
Downloads
Download data is not yet available.
Abstract 2544
PDF Downloads 709
HTML Downloads 259
References
1. Sasaki K, Kantarjian HM, Jain P, et al. Conditional survival in patients with chronic myeloid leukemia in chronic phase in the era of tyrosine kinase inhibitors. Cancer 2016; 122(2): 238–248. doi: 10.1002/cncr.29745.
2. Law AD, Dong Hwan Kim D, Lipton JH. Pregnancy: part of life in chronic myelogenous leukemia. Leuk Lymphoma 2017; 58(2):280—287. doi:10.1080/10428194.2016.1201571
3. Cortes JE, Abruzzese E, Chelysheva E, Guha M, Wallis N, Apperley JF. The impact of dasatinib on pregnancy outcomes. Am J Hematol 2015;90(12):1111—1115. doi: 10.1002/ajh.24186
4. Palani R, Milojkovic D, Apperley JF. Managing pregnancy in chronic myeloid leukemia. Ann Hematol 2015;94(2):S167-S176. doi: 10.1007/s00277-015-2317-z
5. Abruzzese E, Trawinska MM, Perrotti AP, De Fabritiis P. Mediterr J Hematol Infect Dis. 2014 Apr 7;6(1):e2014028. doi: 10.4084/MJHID.2014.028
6. Russel MA, Carpenter MW, Akhtar MS, Lagattuta TF, Egorin MJ. Imatinib mesylate and metabolite concentration in maternal blood, umbilical cord blood, placenta and breast milk. J Perinatol 2007; 27(4):241—243. doi:10.1038/sj.jp.7211665
7. Gambacorti-Passerini CB, Tornaghi L, Marangon E, Franceschino A, Enrico M. Pogliani EM, D'Incalci M, and Zucchetti M. Imatinib concentrations in human milk. Blood. (2007) 109: 1790. doi: 10.1182/blood-2006-08-039545
8. Ali R, Ozkalemkas F,Kimya Y,Koksal N, Ozkocaman V, Gulten T, Yorulmaz H, Tunali A. Imatinib use during pregnancy and breast feeding: a case report and review of the literature. Arch Gynecol Obstet 2009; 280:169–175. doi: 10.1007/s00404-008-0861-7
9. Kronenberger R, Schleyer E, Bornhäuser M, Ehninger G, Gattermann N, Blum S. Imatinib in breast milk. Ann Hematol 2009; 88:1265–1266. doi: 10.1007/s00277-009-0754-2
10. Burwick RM, Kuo K, Brewer D, Druker BJ. Maternal, fetal, and neonatal imatinib levels with treatment of chronic myeloid leukemia in pregnancy. Obstet Gynecol 2017;129:831–4. doi: 10.1097/AOG.0000000000001972.
11. Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-84. doi: 10.1182/blood-2013-05-501569
12. Chelysheva E, Turkina A, Polushkina E et al, Placental transfer of tyrosine kinase inhibitors used for chronic myeloid leukemia treatment. Leuk Lymphoma. 2018; Mar;59(3):733-738. doi: 10.1080/10428194.2017.1347929.
13. Brahm P, Valdés V. The benefits of breastfeeding and risks associated with not breastfeeding. Rev Chil Pediatr. 2017;88(1): 15-21. doi: 10.4067/S0370-41062017000100001
14. Shepherd L, Walbey C, Lovell B. The role of social-cognitive and emotional factors on exclusive breastfeeding duration. Journal of Human Lactation 2017, Vol. 33(3) 606–613. doi: 10.1177/0890334417708187
15. De la Fuente J, Baruchel A, Biondi A, et al. International BFM Group (iBFM] Study Group Chronic Myeloid Leukaemia Committee. Managing children with chronic myeloid leukaemia (CML): recommendations for the management of CML in children and young people up to the age of 18 years. Br J Haematol. 2014;167:33-47. doi: 10.1111/bjh.12977
16. Millot F, Guilhot J, Suttorp M et al, Prognostic discrimination based on the EUTOS long-term survival score within the International for Chronic Myeloid Leukemia in children and adolescents Registry.Haematologica. 2017 Oct;102(10): 1704-1708. doi: 10.3324/haematol.2017.170035
17. Millot F, Guilhot J, Baruchel A et al. Growth deceleration in children treated with imatinib for chronic myeloid leukaemia. Eur J Cancer. 2014 Dec; 50(18):3206-11. DOI:10.1016/j.ejca.2014.10.007
18. Rastogi MV, Stork L, Druker B et al. Imatinib mesylate causes growth deceleration in pediatric patients with chronic myelogenous leukemia. Pediatr Blood Cancer. 2012 Nov;59(5):840-5.
19. Saussele S, Richter J, Hochhaus A, Mahon FX. The concept of treatment-free remission in chronic myeloid leukemia. Leukemia 2016; 30(8):1638–1647. DOI:10.1038/leu.2016.115
20. Hughes TP, Ross DM. Moving treatment-free remission into mainstream clinical practice of CML. Blood 2016; 128: 17—23. doi: https://doi.org/10.1182/blood-2016-01-694265
2. Law AD, Dong Hwan Kim D, Lipton JH. Pregnancy: part of life in chronic myelogenous leukemia. Leuk Lymphoma 2017; 58(2):280—287. doi:10.1080/10428194.2016.1201571
3. Cortes JE, Abruzzese E, Chelysheva E, Guha M, Wallis N, Apperley JF. The impact of dasatinib on pregnancy outcomes. Am J Hematol 2015;90(12):1111—1115. doi: 10.1002/ajh.24186
4. Palani R, Milojkovic D, Apperley JF. Managing pregnancy in chronic myeloid leukemia. Ann Hematol 2015;94(2):S167-S176. doi: 10.1007/s00277-015-2317-z
5. Abruzzese E, Trawinska MM, Perrotti AP, De Fabritiis P. Mediterr J Hematol Infect Dis. 2014 Apr 7;6(1):e2014028. doi: 10.4084/MJHID.2014.028
6. Russel MA, Carpenter MW, Akhtar MS, Lagattuta TF, Egorin MJ. Imatinib mesylate and metabolite concentration in maternal blood, umbilical cord blood, placenta and breast milk. J Perinatol 2007; 27(4):241—243. doi:10.1038/sj.jp.7211665
7. Gambacorti-Passerini CB, Tornaghi L, Marangon E, Franceschino A, Enrico M. Pogliani EM, D'Incalci M, and Zucchetti M. Imatinib concentrations in human milk. Blood. (2007) 109: 1790. doi: 10.1182/blood-2006-08-039545
8. Ali R, Ozkalemkas F,Kimya Y,Koksal N, Ozkocaman V, Gulten T, Yorulmaz H, Tunali A. Imatinib use during pregnancy and breast feeding: a case report and review of the literature. Arch Gynecol Obstet 2009; 280:169–175. doi: 10.1007/s00404-008-0861-7
9. Kronenberger R, Schleyer E, Bornhäuser M, Ehninger G, Gattermann N, Blum S. Imatinib in breast milk. Ann Hematol 2009; 88:1265–1266. doi: 10.1007/s00277-009-0754-2
10. Burwick RM, Kuo K, Brewer D, Druker BJ. Maternal, fetal, and neonatal imatinib levels with treatment of chronic myeloid leukemia in pregnancy. Obstet Gynecol 2017;129:831–4. doi: 10.1097/AOG.0000000000001972.
11. Baccarani M, Deininger MW, Rosti G, et al. European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood. 2013;122(6):872-84. doi: 10.1182/blood-2013-05-501569
12. Chelysheva E, Turkina A, Polushkina E et al, Placental transfer of tyrosine kinase inhibitors used for chronic myeloid leukemia treatment. Leuk Lymphoma. 2018; Mar;59(3):733-738. doi: 10.1080/10428194.2017.1347929.
13. Brahm P, Valdés V. The benefits of breastfeeding and risks associated with not breastfeeding. Rev Chil Pediatr. 2017;88(1): 15-21. doi: 10.4067/S0370-41062017000100001
14. Shepherd L, Walbey C, Lovell B. The role of social-cognitive and emotional factors on exclusive breastfeeding duration. Journal of Human Lactation 2017, Vol. 33(3) 606–613. doi: 10.1177/0890334417708187
15. De la Fuente J, Baruchel A, Biondi A, et al. International BFM Group (iBFM] Study Group Chronic Myeloid Leukaemia Committee. Managing children with chronic myeloid leukaemia (CML): recommendations for the management of CML in children and young people up to the age of 18 years. Br J Haematol. 2014;167:33-47. doi: 10.1111/bjh.12977
16. Millot F, Guilhot J, Suttorp M et al, Prognostic discrimination based on the EUTOS long-term survival score within the International for Chronic Myeloid Leukemia in children and adolescents Registry.Haematologica. 2017 Oct;102(10): 1704-1708. doi: 10.3324/haematol.2017.170035
17. Millot F, Guilhot J, Baruchel A et al. Growth deceleration in children treated with imatinib for chronic myeloid leukaemia. Eur J Cancer. 2014 Dec; 50(18):3206-11. DOI:10.1016/j.ejca.2014.10.007
18. Rastogi MV, Stork L, Druker B et al. Imatinib mesylate causes growth deceleration in pediatric patients with chronic myelogenous leukemia. Pediatr Blood Cancer. 2012 Nov;59(5):840-5.
19. Saussele S, Richter J, Hochhaus A, Mahon FX. The concept of treatment-free remission in chronic myeloid leukemia. Leukemia 2016; 30(8):1638–1647. DOI:10.1038/leu.2016.115
20. Hughes TP, Ross DM. Moving treatment-free remission into mainstream clinical practice of CML. Blood 2016; 128: 17—23. doi: https://doi.org/10.1182/blood-2016-01-694265