To synthesize contemporary evidence on the epidemiology, management, and maternal–fetal outcomes of leukemia during pregnancy and survivorship, and to propose a gestational age–stratified multidisciplinary care pathway. We performed a structured narrative review informed by a systematic search of PubMed, Embase, and Scopus (1 January 2000–30 November 2025), supplemented by citation snowballing. Evidence was prioritized toward multicenter cohorts/registries and international consensus guidance; case reports were used selectively to inform rare, high-stakes decision points. No quantitative meta-analysis was undertaken. Clinical decision-making is chiefly driven by gestational age and the immediacy of disease control. In acute leukemia, timely induction is often required to preserve maternal prognosis. First-trimester diagnoses pose the greatest teratogenic risk; when standard induction cannot be deferred, termination is commonly recommended, whereas pregnancy continuation typically involves intensive counseling and postponement of induction until organogenesis is complete. In the second and third trimesters, anthracycline/cytarabine-based regimens are frequently feasible with obstetric timing adaptations; chemotherapy should be avoided within approximately 3 weeks of delivery, which is ideally planned during hematologic recovery. Acute promyelocytic leukemia requires urgent coagulopathy management; all-trans retinoic acid is a cornerstone after the first trimester, while arsenic trioxide is generally deferred when feasible. For chronic myeloid leukemia, sustained deep molecular response enabling treatment-free remission is preferred preconception; during pregnancy, interferon-α and/or leukapheresis are typical bridging strategies, with cautious consideration of imatinib after organogenesis if response is lost, whereas dasatinib and later-generation TKIs should be avoided. Among survivors, pregnancy is often achievable but warrants preconception risk assessment and high-risk surveillance for cardiomyopathy, venous thromboembolism, and placental dysfunction/fetal growth restriction. A gestational age–stratified, MDT-led pathway aligning leukemia therapy with obstetric timing may preserve maternal curative intent while reducing fetal and neonatal risks. Progress will depend on global registries and long-term offspring follow-up, particularly after in utero TKI exposure.
Zhang et al. (Sun,) studied this question.