Combination chemotherapy with conservative obstetric management in the treatment of pregnant patients with acute myeloblastic leukaemia

Abstract

We have reviewed the management of pregnant women presenting with acute myeloblastic leukaemia (AML) at the London Hospital since 1972. Six women in the second or third trimester were diagnosed with AML over this period. One woman had termination of pregnancy at presentation in the second trimester. Three of the remaining five patients achieved complete remission following chemotherapy during pregnancy. Delivery was achieved by the vaginal route in three and by caesarean section in one patient. All were livebirths but one infant had Down's syndrome. Median maternal survival was 16 months (range 0-44 months). Long-term survival was achieved for both mother and infant in only one case. Longer maternal survival was seen in patients treated in the period 1980-1985. Increased survival appears to be related to the introduction of more aggressive chemotherapy schedules and improved supportive care.

Management of Acute Leukemia during Pregnancy:From the Results of a Nationwide Questionnaire Survey and Literature Survey.

“…However, there is general agreement concerning the initiation of induction therapy in the 2nd-3rd trimesters. Good results are often obtained at a standard or moderately aggressive dose rather than a smaller dose (Bartsch et al 1988;Caligiuri and Mayer 1989;Feliu et al 1988;Gondo et al 1990; Roy et al 1989). In the treatment of pregnant patients with leukemia, a detailed protocol is needed based on the month of pregnancy, avoiding the use of alkylating drugs and antifolic agents and the combination with irradiation.…”

Twin Pregnancy with Acute Myeloblastic Leukemia: Successful Obstetric and Hematological Outcome

“…Reynoso et al, 2 in a review, documented 77% complete remission rates in acute myeloid leukemia, figures similar to the complete remission rates achieved in the nonpregnant patients. Roy et al, 3 in a study of six patients, achieved a complete remission rate of 66%, a rate comparable to one achieved in nonpregnant patients treated with similar protocols; the more aggressive regimens were associated with better survival. Our patient, treated with an intensive combination chemotherapy in standard dosage, confirms this observation.…”

“…5 The use of cytotoxic therapy in the second and third trimesters of pregnancy have not been shown to induce fetal malformation. 2,3,[5][6][7] In our patient, who had twin pregnancy, neither fetus showed any malformations. Juarez et al 6 have reported one case of twin pregnancy associated with leukemia; however, it was accompanied by premature labor and both fetuses were dead.…”

“…Retrospective studies have failed to confirm adverse effects on the offspring of patients treated with cytotoxic agents during the second and third trimesters of pregnancy. [2][3][4][5][6][7] We report a case of twin pregnancy associated with acute myeloblastic leukemia with successful obstetric and hematological outcome. We also report lack of chromosomal abnormalities attributable to in vitro chemotherapeutic exposure in the newborns.…”

Treatment of Acute Myeloid Leukemia During Pregnancy

“…Other adverse effects to the newborn included myelosuppression, hepatopathy, elevated CK, seizures, acrocyanosis, hyaline membrane disease, moderate meningeal hemorrhage, respiratory distress symptoms, and infections. Two cases (case 17 and 19) have reported chromosomal abnormalities: Down's syndrome 25 and inversion on chromosome 9. 36 Growth defects were observed in 4 infants.…”