Pregnancy with acute myeloid leukemia

Update on Leukemia in Pregnancy

“…There are numerous reports of the successful management of AML in pregnancy and few reports of vertical transmission of acute leukemia from the mother to the fetus [48][49][50]. The spontaneous remission of acute leukemia after the termination of pregnancy and the following rare forms of AML have been reported: erythroleukemia, t(8,21) AML with granulocytic sarcoma causing spinal cord compression, and AML mimicking HELLP (hemolysis, elevated liver enzymes and low platelet counts) syndrome [50][51][52][53].…”

“…Therefore, acute leukemia diagnosed during pregnancy should be treated promptly as delay in treatment is associated with higher maternal mortality, but decision on the choice of treatment for acute leukemia during pregnancy should be case-dependent [50,54]. If AML is diagnosed during the first trimester of pregnancy, the immediate termination of pregnancy should be considered then standard induction chemotherapy should be commenced [48,[55][56][57]. Without the termination of pregnancy, combination chemotherapy is associated with an unacceptable high incidence of fetal abnormalities and/or fetal loss [55].…”

“…The management of AML diagnosed during the second and third trimesters of pregnancy is often difficult because delay in administration of chemotherapy implies significant risk to the mother, and administration of chemotherapy may induce: fetal death, prematurity and congenital malformations [55]. There are reports that chemotherapy can be safely given during the second and third trimesters of pregnancy and that induction chemotherapy using cytarabine and idarubicin for AML in the second trimester of pregnancy may be associated with fetal abnormalities including cardiac malformations [48,57]. Close monitoring of the fetus and the mother should be considered when chemotherapy is administered during the second trimester of pregnancy, [58].…”