Treatment of Acute Myeloid Leukemia During Pregnancy

Chang, Amy; Patel, Samit

doi:10.1177/1060028014552516

Cited by 23 publications

(29 citation statements)

References 102 publications

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“…Acute myeloid leukemia (AML) accounts for two-thirds of all cases, while acute lymphoid leukemia, chronic leukemia or myelodysplastic syndrome are rarely described [2–6]. Acute leukemia is usually reported during the second and third trimesters of pregnancy, accounting for 37% and 40% of the cases respectively [3–8]. In the first trimester the incidence is generally estimated around 23%, even if an underreporting bias caused by spontaneous pregnancy termination could not be excluded [3–8].…”

Section: Introductionmentioning

confidence: 99%

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Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

et al. 2017

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BackgroundAcute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Its clinical management remains a challenging therapeutic task both for patient and medical team, given to the therapy-attributable risks for mother and fetus and the connected counseling regarding pregnancy continuation.MethodsWe provided a review of updated literature and a comprehensive description of five maternal/fetal outcomes of AML cases diagnosed concomitantly to pregnancy and treated at our Institution from 2006 to 2012.ResultsMedian age at AML diagnosis was 32 years (31–39). One diagnosis was performed in first trimester and the patient asked for therapeutic abortion before starting chemotherapy. Three cases were diagnosed in second/third trimester; in one case leukemia was diagnosed concomitantly with intrauterine fetal death, while the remaining two patients continued pregnancy and delivered a healthy baby by cesarean section. In only one of these two cases chemotherapy was performed during pregnancy (at 24 + 5 weeks) and consisted of a combination of daunorubicine and cytarabine. Therapy was well tolerated and daily fetus monitoring was performed. After completion of 30 weeks of gestation a cesarean section was carried out; the newborn had an Apgar score of 5/1'-7/5'-9/10', oxygen therapy was temporarily given and peripheral counts displayed transient mild leukopenia. One patient had diagnosis of myelodysplastic syndrome rapidly progressed to AML after delivery. Four out of the 5 described women are currently alive and disease-free. Three children were born and long-term follow-up has shown normal growth and development.ConclusionsThe treatment of AML occurring during pregnancy is challenging and therapeutic decisions should be taken individually for each patient. Consideration must be given both to the immediate health of mother and fetus and to long-term infant health. Our series confirmed the literature data: fetal toxicity of cytostatic therapy clusters during the first trimester; while chemotherapy can be administered safely during second/third trimester and combination of daunorubicin and cytarabine is recommended for induction.

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Section: Introductionmentioning

confidence: 99%

“…Acute leukemia is usually reported during the second and third trimesters of pregnancy, accounting for 37% and 40% of the cases respectively [3–8]. In the first trimester the incidence is generally estimated around 23%, even if an underreporting bias caused by spontaneous pregnancy termination could not be excluded [3–8]. …”

Section: Introductionmentioning

confidence: 99%

Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature

et al. 2017

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“…[26]. The adverse effects of cytotoxic and targeted therapies in pregnant females and newborn infants are summarized in Table 1 [3,[27][28][29][30]. The adverse effects of cytotoxic chemotherapy and radiotherapy in pregnant mothers and fetuses are included in Table 2 [30].…”

Section: Exposure To Cytotoxic Chemotherapy In Uteromentioning

confidence: 99%

“…As AML is an aggressive malignancy, delaying chemotherapy has adverse consequences on the mother so a balance between having the consequences of intensive chemotherapy on both the mother and the fetus as well as the negative impact of postponing chemotherapy on the mother must be carefully evaluated [1,24]. Also, the possibility of long-term consequences of cytotoxic chemotherapy on future fertility of the mother has to be taken into consideration [24,27]. Clinical studies and recent research suggest: (1) a similar prognosis for women treated during pregnancy as compared to nonpregnant patients, and (2) most modern remission induction chemotherapeutic regimens used in the treatment of acute leukemia do not induce sterility [24].…”

Section: Aml In Pregnancymentioning

confidence: 99%

Update on Leukemia in Pregnancy

Al-Anazi¹

2015

Leukemias - Updates and New Insights

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Leukemia is a rare event in pregnancy. Acute leukemia represents % of leukemias occurring during pregnancy with AML accounting for two thirds of these cases.During the first trimester of pregnancy, standard chemotherapy has a teratogenicity rate of up to % depending on the specific agent employed. Exposure to cytotoxic agents during the second and third trimesters is not teratogenic but may predispose the fetus to growth retardation, premature delivery and bone marrow suppression.Additionally, the mother and the fetus are at risk of thromboembolism and sepsis.

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“…Previously there have been only two reports of AML treatment in twin pregnancies, both receiving one cycle of chemotherapy (Chang & Patel, ). To the best of our knowledge, we present the first report of a patient presenting with AML during a twin pregnancy who successfully underwent two cycles of chemotherapy before delivery.…”

mentioning

confidence: 99%