Antenatal chemotherapy in a case of diffuse large B-cell lymphoma

Abstract

A 28-year-old pregnant woman in the sixth month of gestation presented with complaints of altered bowel habit for a month, on examination found to have generalised lymphadenopathy, pedal oedema and locally infiltrating ano-rectal growth. Rectal growth biopsy was reported as high-grade B-cell lymphoma. After a discussion in a multidisciplinary panel consisting of haemato-oncologists, obstetricians and physicians, she was planned to receive antenatal chemotherapy. She delivered a live baby of 1.86 kg at 36 weeks of gestational age by normal vaginal delivery. After 6 cycles of chemotherapy she had complete regression of the disease.

An obstetric challenge in the management of lymphoma in pregnancy

“…Diffuse large B-cell lymphoma is the most common lymphoma seen in pregnancy. 10 ALK-positive ALCL reported to be associated with a better prognosis than ALK-negative ALCL. 11 Most authorities consider cancer CT to be incompatible with breastfeeding.…”

“…3 CT in the first trimester increases the risk of spontaneous abortion, fetal death and 10-20% risk of major fetal malformations. 10 Due to the low molecular weight of the cytotoxic agents, fetus gets exposed to the same as it crosses the placenta easily. 10 CT after the first trimester is likely to be safe and results in acceptable maternal and fetal outcomes.…”

“…10 Due to the low molecular weight of the cytotoxic agents, fetus gets exposed to the same as it crosses the placenta easily. 10 CT after the first trimester is likely to be safe and results in acceptable maternal and fetal outcomes. 5,6 However, it increases the risk of fetal or neonatal death, fetal growth restriction, PROM, induction of labour, caesarean delivery, preterm delivery and low birth weight.…”