Chemotherapy during Pregnancy: Cases of Hodgkin's and Non-Hodgkin's Lymphoma, Chronic Myeloid Leukemia, Breast Cancer, Nasopharyngeal Cancer, and Choriocarcinoma

Abstract

Background: The use of chemotherapeutics during pregnancy is a dilemma for both the patient and the clinician. We report here our 11 years' experience with the use of chemotherapy during pregnancy. Patients: 13 patients undergoing chemotherapy during their current pregnancy were evaluated. The medical data of 5 patients with hematologic malignancies (2 Hodgkin's, 2 non-Hodgkin's lymphoma, and 1 chronic myeloid leukemia), 6 patients with breast cancer, 1 patients with nasopharyngeal cancer, and 1 patient with choriocarcinoma were retrospectively obtained from the ‘perinatal database' of Hacettepe University for the period of January 2002 through March 2016. Results: 4 patients had a medical termination due to teratologic effects. 4 patients had a vaginal delivery, and 5 patients delivered by caesarean section. The 9 newborns who had been exposed to chemotherapeutics were free of congenital anomalies. However, 1 of them died in the early neonatal period due to multi-organ failure (nasopharyngeal cancer). During the 2-year follow-up, we encountered 1 maternal mortality, which was due to multi-organ failure in a non-Hodgkin's lymphoma patient. Conclusion: Physicians must pay attention to potential teratologic problems, and should carefully balance maternal and fetal risks. Selected chemotherapeutic agents can be given in the 2nd and 3rd trimester without any major teratogenic risk. All 9 newborns in our study were free of anomalies, although 1 of them died in the neonatal period.

Lymphomas in pregnancy

“…After the first trimester, ABVD administration is considered safe. 46,48,49 When HL is diagnosed during the third trimester, two options are available: deferring treatment until after delivery, or starting treatment with ABVD, especially in patients with a bulky disease and when the diagnosis occurs early during the third trimester. 50 In NHL, according to the different subtypes and gestational age, different clinical approaches are followed.…”

“…In HL, whenever possible, treatment should be deferred until the end of organogenesis 30 using vinblastine in monotherapy or steroids 46,47 as bridging therapy. After the first trimester, ABVD administration is considered safe 46,48,49 . When HL is diagnosed during the third trimester, two options are available: deferring treatment until after delivery, or starting treatment with ABVD, especially in patients with a bulky disease and when the diagnosis occurs early during the third trimester 50 .…”