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In Reply:

Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston, TX

We appreciate the thoughtful comments from Dr Ali et al. What to do about the therapy with imatinib is frequently an important dilemma for a young patient with chronic myeloid leukemia who wants to become pregnant. This is particularly important for female patients, although the potential consequences that exposure to imatinib may have on the quantity and quality of the sperm, and how these could affect the fetus also have to be considered. It is true that patients who receive imatinib at the time of conception may have normal pregnancies, but this is not always the case, and the data are still limited. Open discussion with the patient, as proposed by Dr Ali and colleagues, is very important, as is educating patients on these issues at the start of therapy, just as one educates patients about the goals of therapy and potential adverse events. Most important, as we have an increasing number of cancer patients living longer and receiving chronic therapy with agents such as imatinib, it is becoming increasingly important to develop adequate models and trials to predict and understand the teratogenicity of these compounds. As pointed out by Dr Ali et al, the currently available animal models are not always good predictors of what may be expected in other species. In addition, prospective investigation of these aspects in patients, with designed uniform strategies (for example, planned interruptions after cytogenetic or molecular remissions, use of alternative interventions during pregnancy) will help us design better strategies to address this important issue.

Authors' Disclosures of Potential Conflicts of Interest

Authors Employment Leadership Consultant Stock Honoraria Research Funds Testimony Other Jorge E. Cortes Novartis Pharmaceuticals (C) Hagop Kantarjian Novartis Pharmaceuticals (C)

Dollar Amount Codes (A) < $10,000 (B) $10,000-99,999 (C) $100,000 (N/R) Not Required

Related Correspondence

• Imatinib and Pregnancy
  Ridvan Ali, Fahir Ozkalemkas, Tulay Ozcelik, Vildan Ozkocaman, and Atilla Ozkan
  JCO 2006 24: 3812-3813 [Full Text]

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