Acute myelogenous leukemia in pregnancy: Fetal blood sampling and early effects of chemotherapy

Abstract

This report documents the acute toxicity of anti-leukemic chemotherapy on the fetus in utero by umbilical blood sampling. A patient with acute myelocytic leukemia diagnosed at the 23rd week of gestation received combination chemotherapy, and carried the pregnancy to successful delivery at the 34th week. During the course of pregnancy, the fetal condition was evaluated by serial real time sonograms and umbilical blood sampling through cordocentesis. Fetal hematopoiesis was preserved against maternal chemotherapeutic agents, and no developmental abnormalities were observed. This is the first attempt to evaluate the acute effects of chemotherapeutic agents on the fetus in utero by real time umbilical cord sampling.

Reversible Foetal Cerebral Ventriculomegaly and Cardiomyopathy under Chemotherapy for Maternal AML

“…All reviews on chemotherapy in pregnancy describe cytopenia as a potential side effect. Morishita et al [13] monitored foetal haematologic effects of maternal chemotherapy with behenoyl cytarabine, daunorubicin, 6-mercaptopurin and prednisolone for AML type FAB M2 via serial umbilical cord sampling [13]. They found preservation of foetal haematopoiesis against maternal chemotherapy-induced anaemia.…”

Reproductive organ transplantation: advances and controversies

“…Most promising options are oocyte and ovarian tissue cryobanking before cancer therapy (38). Proposed strategies to preserve fertility in women with cancer include: [1] storage of frozen embryos, [2] storage of frozen oocytes for future fertilization and embryo transfer, [3] storage of frozen ovarian tissue or the whole ovary for future transplantation, [4] frozen storage of ovarian tissue or isolated follicles for in vitro growth and maturation, [5] ovarian transposition before radiotherapy, [6] hormonal protection with GnRH analogs, and [7] pharmacologic protection with antiapoptotic agents (e.g., sphingosine-1-phospate) and [8] in patients with an absent or nonfunctional uterus-a uterine transplant. Only option 1 is considered nonexperimental and could be offered to willing patients as an established fertility preservation strategy.…”

“…Even today there is a lack of awareness of potential fertility preserving options. Recent publications reporting births from ovarian tissue transplantation (1)(2)(3)(4) have attached a clinical relevance to a previously academic discussion. Reproductive organ loss or damage includes ovarian insufficiency because of premature failure, exposure to radiotherapy and/or chemotherapy, and systemic and genital tract malignancies that result in organ removal.…”

Acute myeloid leukemia in the pregnant patient

“…From the second trimester onwards, growth restriction is the main risk of chemotherapy. Fetal hematopoiesis was not adversely affected and no malformations were observed when chemotherapy was administered during the third trimester (38). However, some organs, including the eyes, genitalia, and hematopoietic and nervous systems, are still vulnerable after the first trimester (31), and transient myelosuppression and increased risk of prematurity or stillbirth have been demonstrated (16,21,39,40).…”