Hematologic Malignancies in Pregnancy

Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature

“…At these doses, no increase in fetal death, growth retardation, or congenital malformation has been observed. 8,13,17,18 However, abdominal and pelvic CT scans and [18F]fluorodeoxyglucose ( 18 F-FDG) positron emission tomography scans entail high radiation exposure and are not recommended during pregnancy. 8 Iodinated contrast agents are deemed safe during pregnancy, allowing the use of gadolinium-enhanced magnetic resonance imaging.…”

“…It can be extremely difficult during early stages to differentiate pregnancy-related physiologic changes from the subtle, early signs of an evolving acute malignancy, and this mimicry may delay a cancer diagnosis. 1,[8][9][10][11][12][13] Interestingly, a recent systematic review of nonHodgkin lymphoma (NHL) in pregnancy observed that aggressive forms of NHL exhibit unique clinical and biological features during pregnancy, including frequent involvement of the reproductive organs (breast, ovary, uterus, and placenta).…”

“…8 Iodinated contrast agents are deemed safe during pregnancy, allowing the use of gadolinium-enhanced magnetic resonance imaging. 13 It is important to assess fetal risk in the context of gestation stage, as the expected severity of damage is greatest during organogenesis, weeks 2-8.…”

“…12 This delay also allows time for fetal elimination of drugs via the placenta, averting excessive renal burden in newborns, especially preterms. Chemotherapy is not recommended after week 35, as spontaneous labor and premature delivery are more likely at this time 13 and may occur during maternal/fetal peripheral blood nadir.…”

“…Articles (continued) (continued) 13 Electronic book section Review of available data about diagnosis and chemotherapeutic treatment of hematologic malignancies during pregnancy and general approach to management of cancer in pregnancy.…”