“Medicine is at its best when science and compassion come together.” This is the story of a young mother whose happiest day became the beginning of an unexpected battle—and how multidisciplinary care changed the course of her life.

A Joyful Beginning with an Unexpected Discovery

A 30-year-old nursing educator, at full-term pregnancy, was admitted to Ujala Cygnus Brightstar Hospital, Moradabad for delivery. Like countless expectant mothers, she looked forward to welcoming her child. However, routine preoperative investigations revealed an alarming abnormality.

Her total leukocyte count (TLC) was approximately 120,000/µL—a number far beyond the physiological elevation expected during normal pregnancy and labor. While minor leukocytosis is common in expectant mothers, counts of this magnitude demand urgent evaluation for an underlying hematological disorder.

Recognising the gravity of this finding, the Obstetrics team immediately requested an emergency consultation from the Department of Medical Oncology. What initially appeared to be routine obstetric admission had suddenly transformed into a complex, multidisciplinary medical challenge.

The First Critical Decision

The immediate and most pressing concern was ruling out acute leukemia—a hematological emergency requiring swift intervention.

An urgent peripheral blood smear was performed. Crucially, no circulating blast cells were identified, significantly reducing the likelihood of acute leukemia. Instead, the smear demonstrated features highly suggestive of a chronic myeloproliferative neoplasm. The patient remained clinically stable, showing no evidence of leukostasis, disseminated intravascular coagulation, or other life-threatening complications

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Following a rapid but comprehensive discussion among the Departments of Obstetrics, Medical Oncology, Hematopathology, and Neonatology, the team reached a carefully considered consensus. Because the pregnancy was full term and the mother’s condition was stable, the delivery could proceed safely.

Shortly after, a healthy baby was delivered successfully by cesarean section. One life had safely entered the world; now, the team's attention turned entirely to saving another.

Establishing the Diagnosis

Once the mother recovered from surgery, she underwent a comprehensive hematological evaluation to pinpoint the exact nature of her condition. The diagnostic workup included:

The investigations confirmed the diagnosis: BCR::ABL1-positive Chronic Myeloid Leukemia (CML), Chronic Phase.

Clinical examination further revealed significant splenomegaly, with the spleen measuring approximately 22 cm, reflecting a substantial disease burden. For the patient and her family, the diagnosis was an unimaginable shock. For the treating medical team, another difficult decision lay ahead.

The Second Critical Decision: Breastfeeding or Immediate Therapy

Modern targeted therapy has transformed Chronic Myeloid Leukemia from a once life-threatening disease into a manageable condition with excellent long-term outcomes. However, given her high white blood cell count, treatment had to begin promptly.

The recommended therapy was Dasatinib 100 mg once daily, a highly effective second-generation tyrosine kinase inhibitor (TKI). The clinical dilemma arose from the fact that Dasatinib is excreted into breast milk. Because robust human safety data in breastfeeding infants remains limited, nursing is generally not recommended once TKI therapy begins.

Conversely, the first few days after birth are vital for neonatal nutrition and immune protection. Colostrum provides antibodies and bioactive factors that are irreplaceable in protecting newborns during their earliest days. Balancing these competing priorities required individualised clinical judgment, empathy, and a departure from a "one-size-fits-all" approach.

A Personalised Treatment Strategy

Following careful counseling and multidisciplinary review, a highly personalised management plan was adopted.

The mother was permitted to breastfeed during the initial 72 hours post-delivery, ensuring her newborn received the critical immunological benefits of colostrum. During this window, the mother’s clinical condition and blood counts were monitored meticulously.

Despite the delivery, her leukocyte count continued to surge, eventually reaching approximately 217,000/µL. This rapid rise indicated that definitive treatment could no longer be safely delayed.

Temporary cytoreduction with Hydroxyurea was administered for three days, alongside supportive care including Febuxostat for hyperuricemia prophylaxis. At this juncture, breastfeeding was gently discontinued, alternative feeding arrangements were established for the infant, and the targeted therapy (Dasatinib 100 mg daily) was initiated. This carefully orchestrated sequence sought to maximize neonatal benefit without compromising maternal survival.

A Remarkable Early Response

The patient’s response to precision therapy was both rapid and profoundly encouraging. Within just 23 days of initiating treatment, the clinical picture transformed:

These findings confirmed an excellent early hematologic response, proving the vital importance of timely diagnosis and the efficacy of modern targeted therapies. Today, during regular follow-ups, both mother and baby continue to thrive.

Why This Case Matters

Chronic Myeloid Leukemia diagnosed during late pregnancy or immediately postpartum is exceptionally rare. This case serves as a powerful reminder of several critical clinical lessons:

 Severe leukocytosis during pregnancy should never be dismissed as purely physiological without a thorough evaluation.

 The peripheral blood smear remains an invaluable, rapid first-line investigation in differentiating chronic myeloproliferative disorders from acute leukemias.

 Early molecular diagnosis is the key to prompt initiation of life-saving targeted therapy.

 The management of CML in the postpartum period demands seamless collaboration across Medical Oncology, Obstetrics, Hematopathology, and Neonatology.

 Decisions regarding breastfeeding in women requiring TKIs must be highly individualized, carefully weighing maternal treatment urgency against neonatal well-being.

The Human Side of Oncology

Cancer rarely arrives at a convenient time. For this young mother, it arrived on the very day she welcomed her first child into the world. What could have easily spiraled into a devastating medical emergency instead became a testament to timely intervention, coordinated multidisciplinary care, evidence-based decision-making, and the life-altering impact of precision medicine.

At Ujala Cygnus Comprehensive Cancer Centre, Moradabad, we believe that every patient deserves more than just a treatment plan. They deserve thoughtful, individualized care grounded in rigorous science and delivered with unwavering compassion. The young mother in this story is now continuing her treatment with confidence, proving that even in the face of the unexpected, there is always hope.

About Chronic Myeloid Leukemia (CML)

CML is a cancer of the blood-forming cells driven by the formation of the BCR:ABL1 fusion gene, commonly known as the Philadelphia chromosome. This genetic alteration triggers the uncontrolled overproduction of white blood cells. The advent of tyrosine kinase inhibitors (TKIs) like Dasatinib has revolutionized the management of this disease. Today, most patients diagnosed in the chronic phase can achieve excellent, long-term disease control and enjoy a near-normal quality of life with strict adherence to therapy and regular medical follow-up.