The management of hodgkin lymphomas in pregnancies

Abstract

Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester.In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second-line chemotherapeutic regimens and timing of consolidation with high-dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient.

Cancer Treatment and Immunotherapy during Pregnancy

“…Non-Hodgkin lymphomas have not been shown to be particularly common during a pregnancy [ 49 ]. When lymphoma is still in its infancy, and the patient remains asymptomatic, it is recommended that the treatment approach be postponed until after delivery [ 52 ]. On the other hand, when there is an advanced stage lymphoma, the administration of treatment regimens is deemed necessary, and some of the following are selected: Cyclophosphamide, vincristine, and prednisone (CVP): This therapeutic option does not appear to present significant defects in fetuses if administered after the first three months of gestation [ 52 ].…”

Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report

“…2 Hôpital universitaire Necker -Enfants malades, Hématologie adultes, F-75015 Paris, France. 3 Hôpital universitaire Necker -Enfants malades, gynécologie-obstétrique, F-75015 Paris, France. 4 Inserm UMR-S 1144, Team "Blood-brain barrier in brain pathophysiology and therapy", Université Paris Descartes, F-75006 Paris, France.…”

Rozpoznawanie i leczenie chorych na chłoniaka Hodgkina

“…W większości przypadków możliwe jest doprowadzenie ciąży do planowego rozwiązania. W celu uniknięcia ekspozycji na promieniowanie jonizujące do oceny stopnia zaawansowania choroby powinno się zastosować rezonans magnetyczny lub ultrasonografię [95]. Choroba rozpoznana w I trymestrze ciąży nie stanowi bezwzględnego wskazania do aborcji.…”

“…We wczesnych stadiach zlokalizowanych powyżej przepony, przy braku cech szybkiej progresji choroby, pacjentka może pozostać pod obserwacją. W przypadku konieczności wdrożenia CTH (obecność objawów B, zaawansowana choroba) można rozważyć stosowanie winblastyny w monoterapii w dawce 6 mg/m 2 co 2 tygodnie [95,96]. Alternatywnie można zastosować napromienianie z wykorzystaniem specjalnych osłon na ograniczone pola małą dawką całkowitą (25 Gy).…”

“…U chorej w zaawansowanej ciąży leczenie można odroczyć do czasu porodu w 32.-36. tygodniu. Rokowanie u chorych na HL rozpoznanego w okresie ciąży nie odbiega od rokowania podobnej populacji chorych niebędących w ciąży [95].…”