Acute lymphoblastic leukemia in pregnancy: a case report with literature review

Abstract

Abstract:The management of acute lymphoblastic leukemia (ALL) during pregnancy requires treatment with high-dose chemotherapy that can pose risks to both the mother and fetus. Special consideration to chemotherapy regimen and its doses and to fetal gestational age at the time of chemotherapy administration should be taken in order to limit fetal exposure while still providing optimal therapy to the mother. Here we describe a 22-year-old patient who was diagnosed at 26 weeks gestation with ALL and was treated in the third trimester with HyperCVAD (cytoxan, vincristine, adriamycin, dexamethasone) combination chemotherapy giving birth via Caesarean section to a healthy baby girl 4 weeks after induction chemotherapy.

How I treat leukemia during pregnancy

“…Regimens in pregnancy have included cytarabine, cyclophosphamide, L-asparaginase anthracyclines, vincristine, and steroids. 42 As with AML, elective delivery after 32 weeks should be planned while aiming to avoid pancytopenia peridelivery.…”

Update on Leukemia in Pregnancy

“…Acute leukemia develops in 1:750,000 pregnancies and ALL accounts for 11-28% of acute leukemia in pregnancy [84,85]. Although ALL is rare in pregnancy, it can be rapidly fatal if left untreated.…”

“…The basic principle of ALL treatment is combination chemotherapy with the sequential administration of induction, consolidation and maintenance therapy and this holds true for ALL in pregnancy [86]. Thus, the management of ALL during pregnancy requires high-dose chemotherapy that can pose risks to both the mother and the fetus [84]. In order to limit fetal exposure to chemotherapy and to provide optimal care to the mother, particular attention should be paid to: the chemotherapeutic regimen to be administered, the doses of the cytotoxic agents to be used and the gestational age at the time of chemotherapy administration [84].…”

“…During the first trimester of pregnancy, chemotherapy used in the treatment of ALL is associated with teratogenicity, stillbirths and abortions, so the termination of pregnancy should be considered and the risks of chemotherapy administered during this part of pregnancy should be discussed with the pregnant mother [84,86]. During the second and third trimesters of pregnancy, the administration of chemotherapy has been widely practiced, although the following adverse events have been reported: intrauterine fetal death and growth retardation, premature delivery, low birth weight, maternal as well as fetal myelosuppression and pre-eclampsia of pregnancy [84,86].…”

“…In a literature review that included 17 patients with ALL treated during pregnancy the following maternal and fetal outcomes were reported: 9 mothers (53%) achieved CRs of their ALLs while 8 patients (47%) either died (5 patients) or had relapse of their leukemia (3 patients) [84]. Thirteen babies (76%) were alive, 4 babies (24%) were dead and 6 babies were delivered by cesarean section.…”