The Management of Lymphoma in the Setting of Pregnancy

Abstract

The diagnosis of lymphoma in pregnant patients poses a therapeutic challenge necessitating consideration of the developing fetus without compromise of therapy with curative potential for the mother. The decision to initiate therapy during pregnancy is heavily influenced by fetal, maternal and disease related factors, of which the most influential are the trimester at diagnosis, the stage and aggressiveness of the disease and the presence of life threatening symptoms. Recent data suggest that deferral of therapy until after the 1st trimester is desirable if it is perceived that postponement of therapy will not compromise maternal outcome. For some patients delay of therapy to the post-partum period is feasible.

Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation

“…Additionally, there was no significant difference in either prenatal or postnatal complications between women treated during the second trimester of pregnancy versus those who deferred treatment until delivery, and a low miscarriage rate of 1.1% was noted (18). A more recent study by Pinnix et al notes an overall miscarriage rate of 10%, but it should be noted that these miscarriages occurred in patients requiring treatment during the first trimester of pregnancy (14,15). …”

“…As a group, lymphoma accounts for 11% of malignancies diagnosed during pregnancy, but given the many presentations at diagnosis and differences in the natural history of each of these entities, little data exists to guide the management of these women. This poses unique challenges to the care of both the mother and the unborn fetus (14,15). Although the goal of treatment is to provide the mother with optimal care while balancing the risks to the fetus, the patient and her providers often encounter many challenges at all stages of management from diagnosis to treatment (14).…”

“…This poses unique challenges to the care of both the mother and the unborn fetus (14,15). Although the goal of treatment is to provide the mother with optimal care while balancing the risks to the fetus, the patient and her providers often encounter many challenges at all stages of management from diagnosis to treatment (14). …”

“…Imaging is generally limited to non-contrast enhanced MRI as both iodine-based and gadolinium contrast materials are teratogenic (14,16). Further challenges exist given conflicting data surrounding the safety during pregnancy of rituximab, which is the backbone of treatment for many types of lymphoma.…”

“…Many studies have shown that in the setting of a well-experienced multidisciplinary team of oncologists, maternal fetal medicine providers, radiation oncologists, and medical ethicists, pregnant patients with lymphoma experience no difference in OS based on the timing of therapy administration, no increased risk of pregnancy complications, and no increased risk of fetal abnormalities (14,15). Additionally, studies have demonstrated that the risk of fetal neurocognitive deficits are related to shorted gestational duration (preterm delivery) rather than chemotherapy exposure itself.…”