Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review

Horowitz, Netanel A.; Benyamini, Noam; Wohlfart, Kristina; Brenner, Benjamin; Avivi, Irit

doi:10.1016/s1470-2045(12)70589-2

Cited by 48 publications

(48 citation statements)

References 82 publications

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“…Stage IV disease was found in 76% of patients, and reproductive organ involvement, including breast, ovary, uterus, and placenta, was reported in 49% of patients. Short-term maternal outcomes were inferior to those reported for young non-pregnant women, at least in the prerituximab era 14. A retrospective cohort of 11 academic centers in the United States strengthened these findings.…”

Section: Non-hodgkin Lymphoma and Pregnancymentioning

confidence: 75%

Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy

Horesh¹,

Horowitz²

2014

Rambam Maimonides Med J

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Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies worldwide. The incidence of NHL has been rising for several decades; however, in the last 20 years, it reached a plateau. NHL incidence among males is significantly higher than in females. In addition to gender itself, gravidity has a protective role against NHL occurrence. Gender also matters in terms of NHL clinical characteristics. For example, female predominance was found in three extra-nodal sites (the breast, thyroid, and the respiratory system) occasionally involved in NHL. The diagnosis of NHL during pregnancy is associated with a unique clinical behavior. It is usually diagnosed in the second or third trimester and in advanced stage. Furthermore, the histological subtype is highly aggressive, and reproductive organ involvement is common. The reduced rate of NHL among females may be explained by direct effects of estrogens on lymphoma cell proliferation or by its effect on anti-tumor immune response. Gender has an important role in responsiveness to standard B cell NHL treatment. Among older adults, women benefited more from the addition of the anti-CD20 antibody rituximab to standard chemotherapy regimens. This phenomenon can be explained by the difference in clearance rate of rituximab that was found to be significantly lower among older females than older males. In mantle cell lymphoma, women receiving lenalidomide have higher rates of response. An understanding of the mechanisms responsible for gender-associated NHL differences will ultimately improve the clinical approach, allowing for a more accurate assessment of prognosis and patient-tailored treatment.

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Section: Non-hodgkin Lymphoma and Pregnancymentioning

confidence: 75%

Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy

Horesh¹,

Horowitz²

2014

Rambam Maimonides Med J

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“…8,14 The patient in our second case had a history of breast mass predating the diagnosis of NHL by several weeks.…”

Section: Discussionmentioning

confidence: 92%

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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“…The dramatic increase in estrogen levels during pregnancy leads to a shift from the prevailing cell‐mediated immunity (Th1) to antibody‐mediated humoral immune (Th2) to protect the fetus . Aggressive development or progression of pregnancy‐induced lymphoma may be associated with the development of lymphoid neoplasm . Among women of reproductive age, the prevalence of aggressive lymphoma such as DLBCL is much higher among pregnant than non‐pregnant women .…”

Section: Discussionmentioning

confidence: 99%

“…Aggressive development or progression of pregnancy‐induced lymphoma may be associated with the development of lymphoid neoplasm . Among women of reproductive age, the prevalence of aggressive lymphoma such as DLBCL is much higher among pregnant than non‐pregnant women . The prevalence of extra nodal lymphoma in reproductive organs is also increased during pregnancy .…”

Section: Discussionmentioning

confidence: 99%

“…Among women of reproductive age, the prevalence of aggressive lymphoma such as DLBCL is much higher among pregnant than non‐pregnant women . The prevalence of extra nodal lymphoma in reproductive organs is also increased during pregnancy . Furthermore, the antibody production‐enhancing Th2 immune response during pregnancy may lead women to be susceptible to antibody‐mediated autoimmune diseases, which would, in turn, increase subsequent lymphoma risk .…”

Section: Discussionmentioning

confidence: 99%

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Female reproductive factors and risk of lymphoid neoplasm: The Japan Public Health Center‐based Prospective Study

Tanaka

Sawada²,

Yamaji³

et al. 2019

Cancer Science

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Although a possible role of reproductive factors in lymphomagenesis has been hypothesized, results of epidemiological studies have been inconsistent. Here, we investigated the association between reproductive factors and the risk of lymphoid neoplasm and its subgroups. We used data from a large‐scale, population‐based prospective study in a Japanese cohort with 42 691 eligible women aged 40‐69 years from 1990 to 1994. During a mean follow up of 18.7 years, we identified 176 cases of lymphoid neoplasm and 90 of non‐Hodgkin lymphoma ( NHL ). A multivariable‐adjusted Cox proportional hazards regression model was used to estimate hazard ratios ( HR ) and 95% confidence intervals (95% CI ) for the risk of lymphoid neoplasms and its subgroups according to self‐reported reproductive factors. Parous women had an increased risk of lymphoid neoplasm compared with nulliparous women ( HR = 2.51, 95% CI , 1.03‐6.13). An increased risk of lymphoid neoplasms was found in women with later onset of menarche (≤13 years old; reference: 14‐15; HR = 1.75, 95% CI = 1.10‐2.79: ≥16; HR = 1.93, 95% CI = 1.17‐3.19: P ‐trend: 0.01) and a shorter menstrual cycle (28‐29 days; reference: ≤27; HR = 1.60, 95% CI = 1.05‐2.43, P ‐trend = 0.81). No association was observed between lymphoid neoplasms and other reproductive factors, including age at first birth, breastfeeding, type of menopause, or exogenous hormone use. Our study suggests that ever parity, late age at menarche and a short menstrual cycle length may be associated with the development of lymphoid neoplasms. The inconsistency seen in epidemiological research to date warrants further investigation.

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Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review

Cited by 48 publications

References 82 publications

Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy

Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy

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

Female reproductive factors and risk of lymphoid neoplasm: The Japan Public Health Center‐based Prospective Study

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