Sucessful Management of Pregnancy and Remission-Induction of a Patient with Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ALL) by Means of Imatinib Mesilate and HyperCVAD.

A 31-year-old female at 25 weeks and 5days of gestation was referred to the hematology department because of thrombocytopenia. Complete blood cell count was as follows; WBC 3,600/ml(blast 8%), RBC 393x10⁴/ml, Hb11.7g/dl, Hct 34%, and Plt 4.4x10⁴/ml. Bone marrow examination revealed peroxidase negative blasts increased 90% in the marrow. The result of karyotype analysis: 47, XX, t(2;7)(p11.2;p13), ider(9)(q10), t(9;22)(q34;q11), der(22)t(9;22), +der(22)t(9;22) [27/30] ;46, XX[3/30]. FISH analysis showed 88.5% of marrow cells were positive for bcr-abl chimeric DNA. To save mother and baby, we decided to operate cesarean section. A 716-gram healthy female was born at 26 weeks and 2days of gestation age. The day after operation, 600mg/day of imatinib mesilate started. One week after operation, the first course of hyperCVAD chemotherapy dose-reduced to 60% (CPA300mg, VCR 2mg, DOX 50mg, Dex 40g) started with 600mg of imatinib mesilate. Intra-thecal MTX 15mg, Ara-C 40mg, and PSL 20mg injection was given on day 8. Bone marrow was examined on day 21. Marrow blast cells were 0%. Karyotype analysis was normal. FISH analysis showed 2.5% cells had bcr/abl chimeric DNA. Major toxicities of the chemotherapy was not observed. She maintains complete remission until now. She has been treated with second course of modified hyperCVAD(MTX 1,000mg, Ara-C 2,000mg, mPSL 50mg) and is being prepared for unrelated umbilical cord blood stem cell transplantation. The baby grows heathy and no major hematological problems has been observed. Here we report the successful management of pregnancy and remission-induction of a mother with Ph+positive ALL at 25-weeks and 5days of gestation by means of imatinib mesilate and hyperCVAD.