A CASE OF CHRONIC MYELOID LEUKAEMIA DIAGNOSED AND MANAGED IN THE THIRD TRIMESTER OF PREGNANCY: MULTIDISCIPLINARY SUCCESS

Abstract

Background: The coexistence of Chronic Myeloid Leukaemia (CML) and pregnancy is rare, posing significant diagnostic and therapeutic challenges. Management requires balancing maternal disease control against fetal safety, particularly in relation to Tyrosine Kinase Inhibitors (TKIs).

Case: A 26-year-old primigravida presented at 28 weeks of gestation with fatigue and abdominal fullness. She had a known diagnosis of CML for two years prior to conception and was receiving TKI therapy. Upon confirmation of pregnancy, TKI therapy was discontinued and she was switched to interferon-alpha once weekly. During the third trimester, investigations revealed marked leucocytosis and thrombocytosis, with evidence of active disease. Bone marrow biopsy and cytogenetics confirmed CML in chronic phase (Philadelphia chromosome positive). A multidisciplinary team comprising obstetrics, haematology, and neonatology managed the case. Due to rising counts and symptom burden, imatinib therapy was reintroduced at 30 weeks after extensive counselling. The pregnancy was closely monitored with serial growth scans and Doppler studies. An elective lower segment caesarean section was performed at 37 weeks, delivering a live male infant weighing 2.8 kg with normal Apgar scores. The neonate showed no immediate abnormalities. The mother achieved haematological remission by 12 weeks postpartum.

Conclusion: With meticulous multidisciplinary planning, careful timing of TKI re-initiation in late pregnancy, and coordinated delivery planning, successful maternal and neonatal outcomes are achievable in pregnancies complicated by CM.