Leukemia and Lymphoma in Pregnancy

Abadi, Uri; Koren, Gideon; Lishner, Michael

doi:10.1016/j.hoc.2011.01.001

Cited by 57 publications

(43 citation statements)

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…Abadi, Koren, and Lishner (2011) 9 Journal article Review of therapeutic options for hematologic malignancies during pregnancy and discussion of optimization of therapy for mother with minimal risk to baby.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

“…9,20 The placenta is an inefficient barrier to cytotoxic drugs, allowing the passage of molecules < 600 kDa (including almost all cytotoxic agents). 10,12 The comparative teratogenicity of individual chemotherapeutic agents depends on their molecular weight, ionization state, lipid solubility, and binding affinity to plasma proteins; therefore, low-molecular-weight, nonionized, highly lipid-soluble, and loosely protein-bound drugs are able to cause the greatest fetal harm.…”

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confidence: 99%

“…68 The overall risk of teratogenicity during the first trimester is considered to be 10-20%; 1,8 the risk is 10% after the use of a single chemotherapeutic agent and 15-25% after combination chemotherapy. 8,9,11,12,23 The greatest risks are from alkylating agents and antimetabolites; vincristine poses the lowest risk. 11 However, in a prospective study by Aviles and Niz of 20 children exposed in utero to intensive ALL chemotherapy between 1963 and 1981 (11 of which were exposed during the first trimester), none showed any congenital malformation, chromosomal abnormality, or late-onset cardiac or neurologic toxicity during follow-up periods ranging from 4 to 22 years.…”

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confidence: 99%

“…37,38 Pregnancy outcome after chemotherapy for ALL Because of the rarity of intensive multiagent ALL chemotherapy during pregnancy, there are few well-controlled studies of its effects. However, despite the fetal toxicities of individual chemotherapeutic agents (Table 3), several retrospective 1,[9][10][11][12][39][40][41][42] and prospective 24,[43][44][45][46][47][48][49] studies of the long-term effects of in utero chemotherapy exposure suggest that standard combination chemotherapy for ALL-even during the first trimester-is not associated with any long-term serious consequences in the child (Table 4). 24,39,42,[44][45][46][47]49,50 The most commonly reported adverse outcomes of pregnancy after first-trimester exposure are spontaneous abortion and intrauterine fetal death; second-or third-trimester exposure is more commonly associated with intrauterine growth retardation and low birth weight.…”

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confidence: 99%

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

Zaidi

Johnson

Church

et al. 2014

Journal of Adolescent and Young Adult Oncology

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The usual age range of acute lymphoblastic malignancies (acute lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma) includes teenagers and young adults (<22 years of age) and coincides with the age of fertility. Concurrence of acute lymphoblastic malignancy with pregnancy is therefore most likely to happen during the younger childbearing ages. However, the therapeutic challenges posed by the dual diagnosis of lymphoblastic malignancy and pregnancy have not specifically been studied in the context of age, and management guidelines for pregnant young patients are lacking. Inconsistency in defining the legal decision-making rights of pregnant teenaged patients adds a further level of complexity in this age group. Management of this challenging combination in the young patient therefore entails unique ethical considerations. Here we present two illustrative cases of teenage pregnancy complicated by acute lymphoblastic malignancy, review the available literature, and offer suggestions for the therapeutic management of such cases in adolescent and young adult patients. Importantly, practical management recommendations are provided in the context of clinical ethics principles that are universally applicable, including in developing countries, where the highest incidence of adolescent pregnancies has been documented.

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

Zaidi

Johnson

Church

et al. 2014

Journal of Adolescent and Young Adult Oncology

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Hematological malignancies and pregnancy: Treat or no treat during first trimester

Avilés

Neri

Nambo

2012

Intl Journal of Cancer

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Treatment of hematological malignancies (HM) during pregnancy remain unsolved, although the use of chemotherapy during second and third trimester has been accepted because of the low rate of toxicities, the use of cytotoxic drugs during first trimester is generally forbidden. Most of the concerns are related to congenital abnormalities and development, but long-term follow-up of these children are not available. From 1975 to 2008, we diagnosed and treated 15,750 cases of HM, and 143 female patients were pregnant during this time that were treated with combined chemotherapy. In our study, we present the long-term follow-up (the median follow-up was 22.4 years with a range of 3.8-32.0 years) of 54 newborns, whose mothers received chemotherapy during the first trimester of pregnancy with an intent-to-cure HM. Physical and neurological development were carefully assessed, and cardiac and chromosomal studies were performed until the age of 20 years to evaluate late toxicities. The obstetrical development of pregnancy was normal, chemotherapy was used at doses and schedules used in normal patients. Low-weight birth was the most frequent finding. No congenital abnormalities were detected. Physical, psychological and neurological developments were normal. Education and academic degree were according to the economical and social factors. Cardiac function and chromosomal examination were normal. No neoplasm or acute leukemia has been observed in these children. Forty-three mothers are alive and disease-free and can be considered cured. The use of cytotoxic drugs during the first trimester to treat HM seems to be beneficial to both the mother and fetus, and chemotherapy during the first trimester can be considered if the cure of the patient is the goal.Cancer is the leading cause of death in women of childbearing age. However, its simultaneous occurrence during pregnancy is uncommon, with a reported incidence of 0.007%-0.2%. The coincident occurrence of pregnancy and cancer present complex therapeutics problems for the patient, oncologist, hematologist, obstetricians and pediatricians, almost legal, ethical and religious problems.The most common hematological malignancies (HM) during pregnancy are acute leukemia (AL), Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). Several studies and recent review articles have analyzed the dilemmas of the diseases associated with pregnancy.

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