successful management of pregnancy and hepatic toxicity in a cml female patient treated with nilotinib : a case report and a review

We report a case of a young patient with HBV hepatopathy, diagnosed with CML in March 2006 and treated with imatinib 400mg/die as first line therapy with concomitant Lamivudine. Patient obtained a complete hematologic response (CHR) in 2 months, complete cytogenetic response (CCyR) in six months and major molecular response (MMR) at 24 months.  After three years of treatment she became imatinib intolerant and resistant.  In November 2009 patient started nilotinib 400mg/BID. Patient tolerated well the new molecule never experiencing hepatic impairment.  After switching to nilotinib she reached in 12 months transcript reduction more than 3 log (MMR).  Even if patient had been informed of the need of continuous therapy and to use effective methods of contraception during TKI treatment, in 2012 she decided to plan a pregnancy.  In August 2012 a MR4 was documented and treatment discontinued before starting pregnancy. She was observed throughout her pregnancy. The disease remained stable achieving an undetectable transcript level; she delivered a healthy boy in September 2013. Treatment with nilotinib was re-started three months after delivery and she is still in molecular remission (MR5). A complete discussion of the case and the available literature will be presented.