Reversible Foetal Cerebral Ventriculomegaly and Cardiomyopathy under Chemotherapy for Maternal AML

Abstract

Background: Leukaemia in pregnancy is a rare complication demanding a multidisciplinary approach and careful management to handle potential complications and cope with ethical dilemmas. Patient and Methods: We report on a patient with acute myeloid leukaemia (AML) relapse in 22 weeks of gestation who received chemotherapy with cytarabine and mitoxantrone, as well as fludarabine, cytarabine, idarubicin, and gemtuzumabozogamicin. We describe findings on regular ultrasound examinations and successful management of complications. Results: The foetus developed signs of anthracyclineinduced cardiomyopathy, transient cerebral ventriculomegaly, anaemia, and intrauterine growth restriction. The child was delivered by Caesarean section at 33 + 1 weeks of gestation. The newborn showed no congenital malformations. Conclusion: This case report confirms that chemotherapy for treatment of AML can be applied in the second trimester of pregnancy under close and careful maternal and foetal monitoring.

Chemotherapy during pregnancy: effect of anthracyclines on fetal and maternal cardiac function

“…Anthracycline use is associated with acute and chronic cardiotoxicity (2). This is well described for children and adults but only anecdotal data are available for fetuses (10,11). In this study we prospectively evaluated maternal and fetal cardiac function by two‐dimensional echocardiography including systolic and diastolic parameters.…”

Treatment of Acute Myeloid Leukemia During Pregnancy

“…In these cases, the 2 births in cases 75 and 82 were uncomplicated, and there were no abnormalities in the infant. 56,62 The fetus in case 4 was spontaneously aborted after chemotherapy was started in the first trimester. 24 Another infant (case 51) was born with shallow sacral dimples, short digits and limbs, and a prominent frontal skull with mild macrognathia.…”

“…Of the 7 mothers who started idarubicin in the second trimester, 6 mothers achieved CR, and 1 mother died from cytomegalovirus (CMV) pneumonia after delivery. 56 There were 6 live births reported, with 1 fetal death. 29 One case of idarubicin use was reported in the third trimester.…”

Fertility, Pregnancy and Childbirth in Patients with Multiple Sclerosis: Impact of Disease-Modifying Drugs

“…A few case reports have described clinical outcomes of pregnancy exposed to mitoxantrone in patients with MS [131][132][133]. After exposure until the 29th week of gestation [131], although foetal growth was reduced, the newborn had no evidence of malformations.…”

“…In a patient treated with mitoxantrone for acute myeloid leukaemia, there were no malformations reported. [132]. On the basis of the available information, women of child-bearing potential undergoing mitoxantrone treatment must be counselled to avoid pregnancy and to use effective birth control methods; pregnancy should be excluded before each infusion [130].…”