Hematological Malignancies and Pregnancy: A Final Report of 84 Children Who Received Chemotherapy In Utero

Avilés, Agustín; Neri, Natividad

doi:10.3816/clm.2001.n.023

Cited by 350 publications

(200 citation statements)

References 12 publications

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“…A further consideration is that alkylating agents may be less teratogenic than antimetabolites, which are considered to be the most injurious of all cytotoxic drugs used [92], [94] and [95]. There is some evidence suggesting that the ABVD combining adriamycin, bleomycin, vinblastine, dacarbazine is safe during pregnancy [93] and [96] as based on case reports. There is only limited experience regarding effects of MOPP [97] and none with the Stanford V or BEACOPP used in high-risk individuals.…”

Section: Management During Pregnancymentioning

confidence: 99%

“…Thereafter such intervention is usually not associated with malformations but has shown to increases the risk of foetal or neonatal death, pre-term delivery and low birth weight [92] and [99]. Women can be safely treated comparably to their non-pregnant counterparts [92], [93] and [96] with full doses given [92], [96] and [98].…”

Section: Management During Pregnancymentioning

confidence: 99%

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Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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Presentation of Hodgkin lymphoma (HL) is distinctive in the infected individual being more advanced, accompanied by B symptoms and the presence of extranodal disease particularly lymphadenopathy of the head and neck. Bone marrow involvement may be found in over 50% of cases. Virtually all co express gamma-herpesvirus. Phenotypically there is prominence of the mixed-cellularity and lymphocyte depleted histopathologic subtypes that define an aggressive clinical course in comparison to other variants. Prior to the induction of cART, median survival was only 1-2 years. Notably the first chemotherapy trial using ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in 21 patients, without treating the viral infection, resulted in a 43% complete remission rate accompanied by severe haematological toxicities but did not extend median survival with this being 1.5 years matching the negative cases.Significant change accompanied concomitant anti-retroviral therapy that could be given safely even with dose intensive regimens exemplified by BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) in 12 patients or the Stanford V regimen (doxorubicin, vinblastine, mechlorethamine, etoposide, vincristine, bleomycin, prednisone) coupled with involved-field radiation for bulky disease studied in 59 patients. BEACOPP extended overall survival (OS) to 83% at 2 years. A similar trend was seen 1 when using the Stanford V regimen with an OS rate of 51% at 3 years, disease-free survival (DFS) of 68% and freedom from progression (FFP) in 60%. Additional benefits accrued from supportive care with stimulatory peptides such as G-CSF and when combined with bacterial prophylaxis results approached that found in the uninfected reference group. Current consensus holds this particular lymphoma as still among the non-AIDS defining cancers being lung, stomach, liver or anal despite these having recently gained more attention as several of these neoplasms may be occurring more commonly in the era of cART.While the relative risk of developing a non-AIDS-defining neoplasm in HIV-infected persons on the average is 2-3 times, the risk for developing HL in HIV-infected cases impressively ranges between 5 and 25 times when compared to the general population. Based on the precedent in which Kaposi sarcoma and the non-Hodgkin lymphomas distinctively alter the course of this retroviral infection in a way indistinguishable from concurrent Hodgkin lymphoma we propose that this entity be similarly regarded and the hypothesis tested in large randomised prospective study.

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Section: Management During Pregnancymentioning

confidence: 99%

Section: Management During Pregnancymentioning

confidence: 99%

Human immunodeficiency and Hodgkin lymphoma

Sissolak

Jacobs

2010

Transfusion and Apheresis Science

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“…The remaining studies found little, if any, detrimental effect on birth outcome among women capable of becoming pregnant (Andrieu and Ochoa-Molina, 1983;Aisner et al, 1993;Brierley et al, 1998). Likewise, a few case series found normal birth outcome in women diagnosed with HD during or shortly after pregnancy (Woo et al, 1992;Anselmo et al, 1999;Aviles and Neri, 2001). …”

mentioning

confidence: 99%

Hodgkin's disease and birth outcome: a Danish nationwide cohort study

et al. 2007

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In a Danish nationwide cohort study of 292 births from 1973 to 2002 in women with Hodgkin's disease (HD), we compared birth outcome with 14 042 births from a cohort of mothers without cancer. We found no substantially increased risk of preterm birth, low birth weight at term, or stillbirth and no difference in proportion of male newborns for 192 children of women with HD before pregnancy. The prevalence odds ratio (POR) for congenital abnormalities was 1.7 (95% confidence interval (CI): 0.9 -3.1). Among 15 newborns of mothers diagnosed during pregnancy, the POR of preterm birth was 26.6 (95% CI: 8.5 -83.0), but five out of the eight preterm deliveries among these women were elective. We found no substantially increased risk of adverse birth outcome among 85 newborns of women diagnosed within 2 years postpartum, though effect estimates were imprecise. The overall findings are reassuring, they cannot exclude the possibility of an increased risk of congenital abnormalities for newborns of women diagnosed with HD before pregnancy.

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“…In a large study, 82 fetuses subjected to chemotherapy during maternal treatment of hematological malignancies were followed up until a mean of 18.7 years of age: no malignancies were encountered and normal physical, neurological and psychological development was observed (71). Breast feeding is not recommended in mothers receiving chemotherapy, biological therapy, endocrine therapy or radiotherapy (25).…”

Section: Systemic Chemotherapy In Pregnant Women With Breast Cancermentioning

confidence: 99%

Pregnancy associated breast cancer and pregnancy after breast cancer treatment

Döğer¹,

Çalışkan²,

Mallmann³

2011

J Turkish German Gynecol Assoc

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Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and radiotherapy after delivery. Even though early stage breast cancers have similar prognosis, advanced stage breast cancers diagnosed during pregnancy and lactation have poorer prognosis than similar stage breast cancers diagnosed in non-pregnant women. Women who desire to become pregnant after treatment of breast cancer will have many conflicts. Although the most common concern is recurrence of breast cancer due to pregnancy, the studies conducted showed that pregnancy has no negative effect on breast cancer prognosis. In this review we search for the frequency of breast cancer during pregnancy, the histopathological findings, risk factor, diagnostic and treatment modalities. We reviewed the literature for evidence based findings to help consult the patients on the outcome of breast cancer diagnosed during pregnancy and lactation, and also inform the patients who desire to become pregnant after breast cancer according to current evidences. (J Turkish-German Gynecol Assoc 2011; 12: 247-55)

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Hematological Malignancies and Pregnancy: A Final Report of 84 Children Who Received Chemotherapy In Utero

Cited by 350 publications

References 12 publications

Human immunodeficiency and Hodgkin lymphoma

Human immunodeficiency and Hodgkin lymphoma

Hodgkin's disease and birth outcome: a Danish nationwide cohort study

Pregnancy associated breast cancer and pregnancy after breast cancer treatment

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