Acute Myelogenous Leukemia in Pregnancy

Cantini, E; Yanes, B.

doi:10.1097/00007611-198408000-00032

Cited by 36 publications

(9 citation statements)

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“…Congenital malformations, including limb malformation, have been associated with its use in the first trimester, either alone or in combination with other chemotherapeutic agents (Wagner et al , ; Schafer, ; Artlich et al , ; Ebert et al , ). Transient cytopenias, intrauterine foetal death, foetal growth restriction and neonatal death secondary to sepsis have been reported with its use during all trimesters (Cantini & Yanes, ; Avilés & Niz, ) though the risk is relatively small.…”

Section: Chemotherapy and Complicationsmentioning

confidence: 99%

Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy

et al. 2015

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Summary of recommendations Pregnant women should be managed by a multidisciplinary team that includes haematologists, obstetricians, neonatologists and anaesthetists (Grade 1C) As for non‐pregnant patients, acute myeloid leukaemia (AML) should be diagnosed using the World Health Organization (WHO) classification (Grade 1A) Women diagnosed with AML in pregnancy should be treated without delay (Grade 1B) When the diagnosis of AML is made in the first trimester, a successful pregnancy outcome is unlikely and spontaneous pregnancy loss in this situation carries considerable risks for the mother. The reasons for and against elective termination should be discussed with the patient (Grade 2C) In the case of presentation beyond 32 weeks gestation, it may be reasonable to deliver the foetus prior to commencement of chemotherapy (Grade 2C) Between 24 and 32 weeks, risks of foetal chemotherapy exposure must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C) The risk‐benefit ratio must be carefully considered before using any drugs in pregnancy (Grade 1C) Where AML induction chemotherapy is delivered, a standard daunorubicin, cytarabine 3 + 10 schedule should be used (Grade 1B) Chemotherapy should be dosed according to actual body weight and adjustments made for weight changes during treatment (Grade 1C) Quinolones, tetracyclines and sulphonamide use should be avoided in pregnancy (Grade 1B) Amphotericin B or lipid derivatives are the antifungal of choice in pregnancy (Grade 2C) Cytomegalovirus (CMV)‐negative blood products should be administered during pregnancy regardless of CMV serostatus (Grade 1B) A course of corticosteroids should be considered if delivery is anticipated between 24 and 35 weeks gestation, given over a 48‐h period during the week prior to delivery (Grade 1A) Use of magnesium sulphate should be considered in the 24 h prior to delivery if this is before 30 weeks gestation (Grade 1A) Where possible, delivery should be planned for a time when the woman is at least 3 weeks post‐chemotherapy to minimize risk of neonatal myelosuppression (Grade 1C) Planned delivery is easier to manage than spontaneous labour; induction of labour is usually advised (Grade 2C) Epidural analgesia should be avoided in a woman who is significantly thrombocytopenic (platelet count <80 × 109/l) and/or neutropenic (white blood cell count <1 × 109/l): (Grade 1C) Elective caesarean section should only be recommended for obstetric indications (Grade 2C) Antibiotics should be administered during and after premature rupture of membranes and delivery (Grade 1C)

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Section: Chemotherapy and Complicationsmentioning

confidence: 99%

Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy

et al. 2015

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“…Historical cases of fetal mortality or malformations have often been exposed to alkylators in combination with radiotherapy or other chemotherapy. Despite this, there is some evidence of safety in the second and third trimesters, with only a small proportion of fetal fatalities (Cantini & Yanes, ; Warkany et al , ).…”

Section: Pharmacology Of Chemotherapy In Pregnancymentioning

confidence: 99%

“…Over 100 cases of vinca alkaloid exposures are reported in pregnancy, with malformations typically only noted following first trimester exposure. Examples of fetal or neonatal deaths typically involve exposure to multiagent chemo‐radiotherapy (radiotherapy, doxorubicin and prednisolone in case one; prednisolone and epirubicin in case two, ifosfamidine and dactinomycin in case three and 6‐mercaptopurine, methotrexate, cytarabine and prednisolone in case four) (Cantini & Yanes, ; Fernandez et al , ; Karp et al , ; Peres et al , ).…”

Section: Pharmacology Of Chemotherapy In Pregnancymentioning

confidence: 99%

Management and controversies of classical Hodgkin lymphoma in pregnancy

et al. 2015

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SummaryThe goal of managing classical Hodgkin lymphoma (cHL) in pregnancy is to obtain good long-term outcomes for both the mother and fetus. Given the excellent outcomes outside of pregnancy, the goal of treatment should remain curative. There remains a tension and debate regarding the timing of chemotherapy, the curative nature of such treatment and the timing of delivery. Moreover, the aim during pregnancy should be to minimize fetal toxicity and optimize perinatal outcomes. The management of cHL within pregnancy was covered within the excellent recent British Committee for Standards in Haematology guidelines, but with necessary brevity. By reviewing the literature over the last 30 years, herein we discuss the options for management during each trimester. Critical organogenesis occurs between 2 and 8 weeks post-conception; during which time the immature fetus is vulnerable to cytotoxic exposure. We discuss the evidence for using ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and single agent vinblastine in the first trimester. cHL presenting in pregnancy raises complex and difficult ethical dilemmas that can cause anxiety for patients, families and physicians. Decision-making must be multi-disciplinary and holistic, taking into account the patient's wishes, psycho-social and religious beliefs and personal circumstances. Clear communication between the haemato-oncologist, medical obstetrician, nurse specialists, midwives and neonatologists is paramount to a successful outcome.

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“…[58][59][60][61] Transient cytopenias, intrauterine fetal death, fetal growth restriction and neonatal death secondary to sepsis have been reported with its use during all trimesters though the risk is relatively small. [62][63][64] Gemcitabine, a nucleoside analog, often used in relapsed HL, is another possible agent. 51,52 However, it has been shown to cross the placenta and to cause fetal malformations at supratherapeutic doses in rats and mice.…”

Section: Case Discussionmentioning

confidence: 99%

The management of hodgkin lymphomas in pregnancies

Moshe

Bentur

Lishner

et al. 2017

European J of Haematology

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Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester.In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second-line chemotherapeutic regimens and timing of consolidation with high-dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient.

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Acute Myelogenous Leukemia in Pregnancy

Cited by 36 publications

References 0 publications

Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy

Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy

Management and controversies of classical Hodgkin lymphoma in pregnancy

The management of hodgkin lymphomas in pregnancies

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