Hematological malignancy and pregnancy: a single-institution experience of 21 cases

Abstract

The incidence of hematological malignancies during pregnancy is low, and treatment in this setting is problematic. This study observed 21 pregnancies in 18 patients with hematological malignancies. Patients' ages were between 19 and 43 (median 25) years. Two pregnancies ended with spontaneous abortion, one pregnancy ended with in utero death, three therapeutic abortions were carried out, and 15 infants were born alive but three of them died later. The median birth weight was 2.47 kg. Twelve babies survived to a median age of 36 (range 4-117) months. Eight babies were exposed to chemotherapy during the in utero period. One baby was exposed to chemotherapy during all the trimesters and was born prematurely and later died because of intracranial bleeding. Four babies were exposed to chemotherapy during the first trimester, one of them had low birth weight and floating thumb malformation, two of them had only low birth weight, and one was born healthy, but died at 3 months of age as a result of severe gastroenteritis. Two babies were exposed to chemotherapy during the second and third trimesters; one of them had low birth weight, and the other pregnancy ended in in utero death. One infant was exposed to chemotherapy during the third trimester and was born at term, but died because of pulmonary hemorrhage. We concluded that chemotherapy during all trimesters of pregnancy carries a significant risk for an unfavorable outcome.

Three cases of hematologic malignancies in pregnancy: Still difficult to diagnose and hard to treat

“…Due to chemotherapy for the disease, intrauterine growth retardation was reported in some articles, that is compatible with our first case 7,8 . The preterm contractions after cytotoxic treatment are one of the main obstetrical problems.…”

Acute lymphoblastic leukemia during gestation

“…Standard antileukemic chemotherapy can be administrated safely during the second and third trimesters [10,11]. During the first trimester, chemotherapy agents cause teratogenicity in 10-20% [2], whereas later in pregnancy intrauterine exposure does not increase the risk of fetal malformations, compared to that of general population (3%) [2,9,12]. The teratogenicity of any drug depends on the timing of exposure, the dose, and the individual drug characteristics affecting placental transfer.…”

“…Genetic predispositions to teratogenicity explain why people given the same agents have differing susceptibility. Exposure during the second and third trimesters increases the risk of intrauterine growth restriction (IUGR), low birthweight, and fetal death [12]. Maternal nutritional deficiencies, caused by the tumor or by chemotherapy-induced anorexia, can also affect fetal growth and birthweight [5].…”

An unusual hotspot in a young woman with Hodgkin's lymphoma

“…As little evidence exists on this subject, 4,7 we would like to emphasize the importance of more research on this subject and a better registration of concurrent pregnancy and malignancy. …”