When Cancer Meets Crisis: Chronic Myeloid Leukemia, Severe Preeclampsia and a Surprise Ectopic Pregnancy in a Rare Multidisciplinary Case

Abstract

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the BCR-ABL1 fusion gene resulting from the t(9;22)(q34;q11) translocation. The advent of tyrosine kinase inhibitors (TKIs), particularly imatinib, has significantly improved the prognosis of CML. However, the management of CML during pregnancy poses challenges due to the teratogenic potential of TKIs and the risk of disease progression upon their discontinuation. We report the case of a 23-year-old primigravida with a 9-year history of CML managed with imatinib 400 mg/day. Upon confirmation of pregnancy, imatinib was discontinued. At 38+2 weeks of gestation, she presented with severe preeclampsia and underwent induction of labor with dinoprostone, which failed. A cesarean section under general anesthesia was performed, resulting in the delivery of a low-birth-weight infant (2.3 kg) without complications. Postoperatively, the patient resumed imatinib therapy. This case underscores the complexities in managing CML during pregnancy, balancing the teratogenic risks of TKIs against the potential for disease progression. The decision to use general anesthesia was influenced by concerns over central nervous system (CNS) contamination by circulating blasts during neuraxial anesthesia, despite the patient not being in a blast crisis. Multidisciplinary management like involvement of oncologist, gynecologist and anesthesiologist is crucial in pregnant patients with CML. General anesthesia may be preferred over neuraxial techniques in certain scenarios to mitigate potential CNS complications. Further research is needed to establish standardized guidelines for the anesthetic management of such patients.