RESUMO
The development of tyrosine-kinase inhibitors (TKIs) has improved survival of patients with chronic myeloid leukemia (CML). Some patients may become resistant to TKIs and require hematopoietic stem cell transplant (HSCT) that is highly gonadotoxic. Fertility preservation with ovarian stimulation might be indicated but is challenging if patients need to remain on TKIs until HSCT because TKIs may compromise follicular development and response to ovarian stimulation. We report the case of a patient with CML resistant to TKI and planned for an HSCT, in which treatment by TKI was replaced by interferon-α before and during ovarian stimulation for fertility preservation. Successful ovarian stimulation was performed, allowing cryopreservation of nine zygotes. Hematopoietic stem cell transplantation was performed, and at present, 3 years later, the patient presents a sustained major molecular response.
Assuntos
Preservação da Fertilidade/métodos , Interferon-alfa/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Indução da Ovulação/métodos , Proteínas Tirosina Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Adulto , Feminino , Humanos , Interferon-alfa/farmacologia , Proteínas Tirosina Quinases/farmacologia , Pirimidinas/farmacologiaRESUMO
The development of assisted reproductive technology (ART) has led to the birth of nearly 6 million children since the first IVF baby in 1978. For many years, it was routine practice to transfer multiple embryos in order to obtain the highest pregnancy rates. This strategy has induced a dramatic increase in multiple pregnancies and the associated complications for the mother and the child. Following better awareness of these issues, ART specialists have tried to reduce multiple pregnancy rates with the goal of producing a single, healthy full term baby. Improvement in embryo culture and cryopreservation are the key factors leading to the strategy of elective single embryo transfer (eSET) which represents the best option to achieving this goal. However eSET strategy needs to be implemented in good prognosis patient with good quality embryos.
Le développement des techniques de procréation médicalement assistée (PMA) a permis la naissance de presque 6 millions d'enfants depuis le premier bébé né par FIV en 1978. Pendant de nombreuses années, le transfert de plusieurs embryons était réalisé de routine afin d'obtenir les meilleurs taux de grossesses. Cette pratique a abouti à une augmentation inquiétante des grossesses multiples et des complications associées pour la mère et l'enfant. Les acteurs de la PMA ont alors eu comme but la naissance à terme d'un enfant en bonne santé. Les techniques de culture et de cryoconservation d'embryons ont permis de développer des stratégies de transfert électif d'un seul embryon (eSET). Toutefois, pour ne pas diminuer les chances de grossesses, l'eSET doit être utilisé chez des patientes à bon pronostic et avec des embryons de bonne qualité.