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

Abstract

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.

Pregnancy and Acute Lymphoblastic Leukemia: A Case Series and Review of Literature

“…Some modifications have also been recommended with regard to L-asparaginase and intrathecal methotrexate in view of risk of thromboembolism and fetal aminopterin syndrome. 18 In our literature search, we found 11 pregnancies in the first trimester with ALL, 8 of whom underwent therapeutic abortion prior to starting chemotherapy and 2 had spontaneous abortion and only 1 pregnancy resulted in a live birth (premature) where induction was with only vincristine and prednisolone. [4][5][6]10,12 Management of leukemia in second trimester: In our report, both patients with second-trimester pregnancies presented with complications for which several key modifications were made and the results were favorable.…”

Low rates of pregnancy screening in adolescents before teratogenic exposures in a national sample of children's hospitals

“…Clinicians typically are not adept at identifying risky sexual behaviors among youth with chronic illnesses, including cancer. [3][4][5][6][7][8][9][10][11] Pregnancy can also be easily overlooked, particularly in adolescence, because the symptoms are often nonspecific.…”