Idarubicin Administered during Pregnancy: Its Effects on the Fetus

Matsuo, Koji; Shimoya, Koichiro; Ueda, Shuji; Wada, Kazuko; Koyama, Masayasu; Murata, Yuji

doi:10.1159/000079814

Cited by 29 publications

(11 citation statements)

References 10 publications

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“…[7] There are also no data to support the use of higher dose of daunorubicin and this approach is not recommended for increased toxicity [7]. Idarubicin, for its lipophilic characteristics, has an increased placental transfer and higher potential foetal toxicity, and therefore daunorubicin remains the anthracycline of choice [12, 16–20, 23]. It is highly advisable to monitor fetal cardiac function for anthracycline rare cardiotoxicity and limb morphogenesis for teratogenic potential of cytarabine (10%) [7, 16–24].…”

Section: Discussionmentioning

confidence: 99%

Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

et al. 2017

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BackgroundAcute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Its clinical management remains a challenging therapeutic task both for patient and medical team, given to the therapy-attributable risks for mother and fetus and the connected counseling regarding pregnancy continuation.MethodsWe provided a review of updated literature and a comprehensive description of five maternal/fetal outcomes of AML cases diagnosed concomitantly to pregnancy and treated at our Institution from 2006 to 2012.ResultsMedian age at AML diagnosis was 32 years (31–39). One diagnosis was performed in first trimester and the patient asked for therapeutic abortion before starting chemotherapy. Three cases were diagnosed in second/third trimester; in one case leukemia was diagnosed concomitantly with intrauterine fetal death, while the remaining two patients continued pregnancy and delivered a healthy baby by cesarean section. In only one of these two cases chemotherapy was performed during pregnancy (at 24 + 5 weeks) and consisted of a combination of daunorubicine and cytarabine. Therapy was well tolerated and daily fetus monitoring was performed. After completion of 30 weeks of gestation a cesarean section was carried out; the newborn had an Apgar score of 5/1'-7/5'-9/10', oxygen therapy was temporarily given and peripheral counts displayed transient mild leukopenia. One patient had diagnosis of myelodysplastic syndrome rapidly progressed to AML after delivery. Four out of the 5 described women are currently alive and disease-free. Three children were born and long-term follow-up has shown normal growth and development.ConclusionsThe treatment of AML occurring during pregnancy is challenging and therapeutic decisions should be taken individually for each patient. Consideration must be given both to the immediate health of mother and fetus and to long-term infant health. Our series confirmed the literature data: fetal toxicity of cytostatic therapy clusters during the first trimester; while chemotherapy can be administered safely during second/third trimester and combination of daunorubicin and cytarabine is recommended for induction.

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Section: Discussionmentioning

confidence: 99%

Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

et al. 2017

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“…Fifteen cases of TNM, including our case, were identified [4][5][6][7][8][9] . Only 7 cases included full details on pregnancy, maternal outcome, chemotherapy, neonatal presentation of TNM, treatment, and clinical course ( tables 1 , 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Supportive care of infants with TNM included thrombocyte and/or erythrocyte transfusions, bedside isolation, erythropoietin, and recombinant human G-CSF [4][5][6][7]9] . The duration of therapy varied depending on the duration and clinical course of TNM.…”

Section: Discussionmentioning

confidence: 99%

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Transient Neonatal Myelosuppression after Fetal Exposure to Maternal Chemotherapy

Cate¹,

Hove²,

Nix

et al. 2008

Neonatology

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Transient neonatal myelosuppression (TNM) is a rare but potentially life-threatening adverse effect of fetal exposure to maternal chemotherapy during pregnancy. We report a case of TNM in a preterm infant born to a mother diagnosed with acute lymphoblastic leukemia during pregnancy. The mother received chemotherapy during the second and third trimester. The neonate was successfully treated with supportive care. In addition, we also conducted a medical literature review and identified another 14 cases of TNM. Although the long-term outcome of these children is not known, short-term survival is relatively good. Prompt recognition and aggressive treatment of infants at risk for TNM is mandatory.

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“…Close monitoring of the fetus and the mother should be considered when chemotherapy is administered during the second trimester of pregnancy, [58]. However, the administration of standard chemotherapy including idarubicin during the third trimester of pregnancy may increase the chances of CR of AML without adversely affecting fetal outcome or increasing the risk of leukemia in the offspring [55,59]. In selected AML patients presenting in late pregnancy, it is possible to offer leukapheresis and blood product transfusions and to plan early delivery [55].…”

Section: Aml In Pregnancymentioning

confidence: 99%

Update on Leukemia in Pregnancy

Al-Anazi¹

2015

Leukemias - Updates and New Insights

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Leukemia is a rare event in pregnancy. Acute leukemia represents % of leukemias occurring during pregnancy with AML accounting for two thirds of these cases.During the first trimester of pregnancy, standard chemotherapy has a teratogenicity rate of up to % depending on the specific agent employed. Exposure to cytotoxic agents during the second and third trimesters is not teratogenic but may predispose the fetus to growth retardation, premature delivery and bone marrow suppression.Additionally, the mother and the fetus are at risk of thromboembolism and sepsis.

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Idarubicin Administered during Pregnancy: Its Effects on the Fetus

Cited by 29 publications

References 10 publications

Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

Transient Neonatal Myelosuppression after Fetal Exposure to Maternal Chemotherapy

Update on Leukemia in Pregnancy

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