Treatment of Early Stages Hodgkin Lymphoma During Pregnancy

Abstract

BackgroundTo assess maternal and fetal outcome of women and newborns who received chemotherapy during pregnancy to treat Hodgkin lymphoma (HL)in early stages (IA, IIA), we performed a retrospective analysis of a cohort of 44 pregnant women with HL and early stages, diagnosed and treated between 1988 to 2013, at a tertiary reference cancer center.MethodsWe analyzed data on HL characteristics and treatment, with a particular attention to maternal and fetal complications; in children, we performed a longer follow-up to detect any anomaly in physical development, scholar performance, psychological, cardiac, neurological function, and intelligence tests.ResultsMedian age was 29.4 (range 21–37) years; Most patients were stage IIA (86%), had M a bulky mediastinal disease (78%) and 60% had > 3 nodal sites involved; thus these patients were considered to have a not favorable condition. Abortion was refused when it was proposed. All patients received chemotherapy during pregnancy; ABVD (adryamicin, bleomycin, vinblastine, and dacarbazine) at standard doses and schedule, even during the first trimester. Radiotherapy, when indicated, was administered after delivery in 39 patients. No obstetrical complications were observed, delivery occurred between 33 to 36 weeks in 10 cases (22%); and >37 weeks in 34 cases (87%). Four newborns were low-weight: 2012 g median (range 1750 – 2350 g). No clinical malformations were observed, and development of newborns was physiological without evidence of cardiac and neurological damage, behavior, intelligence, and scholar attendance were normal. At median follow-up range of 120.4 (48–299) months, the progression-free survival and overall survival of patients were 95% and 93%respectivelyConclusionCombined chemotherapy, as initial therapy appears to be the best approach in this setting of patients, with an excellent outcome to both mothers and children. If radiotherapy is necessary, it could be administered after delivery.

Obstetric and maternal outcomes in patients diagnosed with Hodgkin lymphoma during pregnancy: a multicentre, retrospective, cohort study

“…Another series on 44 pregnant patients with chemotherapy for early stage HL during pregnancy reported 22% preterm delivery, but no other obstetric complications. 10 A breast cancer series also found a higher obstetric complication rate in patients receiving antenatal cancer treatment compared to patients without antenatal treatment, but similar to this HL series, no specific complication was significantly more prevalent in the exposed group. 21 In one cohort study caesarean section or induction of labour were considered as complications and were more common in the non-exposed group.…”

“…We did not find an increased rate of neonatal morbidity in this series, consistent with prior data. 8,10,13 The major congenital malformation rate was comparable to that of the general population, with a background risk of 2•8 to 6•9% for major malformations and 6•5 to 35•8% for minor abnormalities. 25,26 In the literature of the non-pregnant population 5 year PFS ranges between 86•4 and 94•2% and 5 year OS between 96•0 and 98•8% for early stage HL.…”

“…13 A recent report on 44 patients diagnosed with early stage HL during pregnancy with median follow-up of 11•5 years revealed an OS of 95%, whereas our series found an OS of 98% at 10 years in this subgroup. 10 Small differences between the studies might be explained by different adverse prognostic factors of HL, such as presence or absence of B symptoms and bulky disease. 13,14 Based on gestational changes, there are some reasons to assume a plausible suboptimal cancer treatment in pregnant patients.…”

“…Most series report on the use of ABVD during pregnancy, whereas experience with BEACOPP during pregnancy is limited. 9,10 Some authors suggest deferral of treatment until after delivery to minimise foetal risks in early stage HL. 9 However, in symptomatic patients or advanced HL, immediate treatment is often indicated.…”

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

“…protocol remains the current treatment for HL in pregnancy in North America and Europe [13,14]. Small case series and retrospective studies in pregnancies treated for HL reported that doxorubicin was safe for the fetal heart when administered during the second and third trimester [9,12,[15][16][17]. But they reported that doxorubicin in pregnancy could reduce the thickness of the left ventricular wall without causing heart defects or functional disorders [15].…”