Real-World Outcomes of Pregnancy in Chronic Myeloid Leukemia in a Resource-Limited Setting

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Pregnancy in chronic myeloid leukemia (CML) remains challenging due to interruption of tyrosine kinase inhibitors (TKIs), risking loss of disease control. Evidence from resource-limited settings is scarce, limiting generalizability of current recommendations. We performed a 5-year retrospective study of pregnant women with CML at a tertiary referral center. Clinical features, treatment patterns, and hematologic and molecular responses were evaluated pre-pregnancy, during pregnancy, and postpartum. Maternal and neonatal outcomes were assessed. Twenty-six pregnancies (27 fetal outcomes) were analyzed. All patients were in chronic phase at conception; 59.1% achieved major molecular response (MMR) or deeper, and 70.0% were in complete hematologic response (CHR). Most pregnancies were unplanned, with 75% discontinuing TKIs after conception. Disease control deteriorated during pregnancy: CHR declined to 23.5% by the third trimester, with mean white blood cell count peaking at 95.82 ×10 9 /L. Molecular monitoring was limited (25%), and only one patient maintained deep molecular response. Management was largely reactive, with 59.1% receiving no therapy, 36.3% hydroxyurea, and 4.5% interferon-α. Postpartum recovery was incomplete (CHR 50.0%, deep molecular response 35.3%), and two patients (11.1%) progressed to blast phase. No maternal deaths occurred. Fetal outcomes were favorable (85.2% live births, no congenital anomalies), though preterm delivery (45.8%) and low birth weight (25.0%) were common. In this real-world cohort, pregnancy in CML demonstrates striking maternal–fetal outcome divergence: preserved fetal outcomes alongside frequent maternal disease destabilization. These findings highlight critical gaps in monitoring and treatment access and support development of pragmatic, resource-adapted management strategies for CML in pregnancy.