Therapeutic challenges in the management of chronic myeloid leukemia during pregnancy: A report of two cases

Chronic myeloid leukemia (CML) during pregnancy is a rare clinical condition that poses significant therapeutic challenges, as maternal disease control must be balanced against fetal safety. Evidence-based management guidelines remain limited, particularly in settings with restricted access to pregnancy-compatible therapies. This report presents two cases of pregnant patients with chronic-phase CML who conceived without adequate hematologic control due to irregular tyrosine kinase inhibitor therapy and lack of access to interferon-alpha. The first case involved a woman at 33 weeks of gestation requiring an urgent preterm cesarean delivery for nonreassuring fetal status, complicated by significant postoperative hemoperitoneum, while her neonate required a prolonged stay in an intensive care unit. The second case concerned a patient at 25 weeks of gestation who was successfully managed with cytoreductive therapy using cytarabine, achieving hematologic stabilization and term delivery, though complicated by immediate postpartum hemorrhage. In both cases, treatment was guided by multidisciplinary decision-making and local availability of treatments. These cases demonstrate that CML during pregnancy carries a high risk of adverse maternal and perinatal outcomes when preconception counseling is absent, disease control is suboptimal, and access to recommended first-line therapies is unavailable. The clinical experience emphasizes the importance of individualized multidisciplinary care, robust family-planning counseling, and equitable access to safe, effective therapies to optimize outcomes for both mother and fetus.