Myelodysplastic syndromes presenting in pregnancy: A report of five cases and the clinical outcome

Abstract

Five female patients, ranging in age between 22 and 36 years, presented with myelodysplastic syndromes during pregnancy between June 1982 and March 1987. Three of these five cases evolved into acute leukemia. A bone marrow transplant was attempted in the fourth. It is suggested that the association of myelodysplastic syndromes during pregnancy is more than coincidental and that acute leukemia evolves in a majority of these cases. Furthermore, refractory macrocytic anemias in pregnancy need to be carefully evaluated for a primary myelodysplastic state. Cancer 66:377-381,1990, HE MYELODYSPLASTIC SYNDROMES (MDS) are aT group of hematologic disorders that manifest dysplastic hematopoiesis and usually a hypercellular bone marrow. Ineffective hematopoiesis leads to hematologic failure in these syndromes. In 20% to 70% of these cases acute nonlymphocytic leukemia eventually evolve.'-3 Although MDS largely affects older individuals (70 years of age or older), no age group is spared, and in fact, 10% of the patients are younger than 40 years of age.4 Myelodysplastic syndromes may be primary when it is of unknown cause, and secondary when preceded by some known inciting event, usually exposure to chemotherapy and/or radiotherapy.' In 1982, the French-AmericanBritish (FAB) classification was introduced which has resulted in the creation of five subsets of MDS. This classification is now widely used resulting in better standardization when evaluating MDS and its evolving concepts.6At the University of Florida hospitals, five patients have been seen between 1982 and 1987 whose anemia or MDS presented initially during pregnancy. A review of the literature has revealed no information about such occurrences and their clinical behavior. The aggressive clinical

Management of hematological malignancies during pregnancy

“…A fistful of cases of myelodysplastic syndrome (MDS) and pregnancy was identified [169][170][171][172][173][174][175][176][177][178][179], and in general terms fewer than 40 cases have been reported. In the larger series [173,[176][177][178], patients tend to have lower risk disease and managed with red blood cell and platelet transfusions, as needed. Few cases have reported the use of erythropoietin in MDS during pregnancy [175].…”

“…Few cases have reported the use of erythropoietin in MDS during pregnancy [175]. The risk of transformation into AML has not been studied extensively, but the rate of transformation varies between 25 and 60% [176,177]. However, an Italian study with a follow up of 9 years did not report transformation into AML [178].…”

Maternaler Todesfall im Wochenbett bei Erstdiagnose eines myelodysplastischen Syndroms während der Schwangerschaft – Ein Fallbericht

“…Hierbei sind jedoch sicherlich im Einzelfall der histologische Subtyp der Erkrankung und die daraus erfolgende Prognose zu berücksichtigen. In 3 von 7 in der Literatur dokumentierten Fällen erfolgte jedoch eine schnelle Progression des MDS in eine AML während der Schwangerschaft [7,8]. Die AML hat eine allgemeine Inzidenz von 3-4/100 000/Jahr, zunehmend mit steigendem Lebensalter auf 15/100 000/Jahr [2].…”

“…Das leukämiefreie 5-Jahre-Überleben variiert je nach Karyotyp von 10-70 % und die Erkrankung hat somit eher eine mäßige bis schlechte Prognose [2]. In der Literatur herrscht Einigkeit darü-ber, dass die Schwangerschaft per se keinen Effekt auf den Verlauf und das Outcome der Erkrankung hat und dass die Prognose der Erkrankung während der Schwangerschaft vergleichbar der für nicht schwangere Frauen ist [5,[7][8][9][10][11][12][13]. Dies gilt jedoch nur, sofern therapiert wird.…”

“…Dies gilt jedoch nur, sofern therapiert wird. Die Therapie entspricht der Therapie außer-halb der Schwangerschaft, d. h. eine Chemotherapie sollte ohne Zeitverzögerung gegeben werden [5,[7][8][9][10][11][12][13][14]. Allerdings sind diese Schwangerschaften als Risikoschwangerschaften einzustufen und zu betreuen, denn das Risiko für Malformationen, Abort, IUGR (intrauterine Wachstumsretardierung), IUFT (intrauteriner Fruchttod) und Frühgeburt ist unter Therapie in unterschiedlichem Ausmaß erhöht [5,[7][8][9][10][11][12].…”