Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting

Abstract

This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aim for optimal treatment of the mother, while protecting fetal and pediatric health.

Adolescent and Young Adult Oncology, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…[165][166][167] There is insufficient evidence regarding the safety of gadolinium-based contrast agents in pregnant women. 167 Surgery is possible at any time during pregnancy depending on the anatomic location of the tumor, although it may be beneficial to delay surgery, when possible, until after fetus viability.…”

“…Granulocyte-colony stimulating factors for the management of neutropenia and antiemetics for the management of nausea and vomiting have been used in pregnant women without any significant side effects. 166,181,183,184 The panel members acknowledged that the management of cancer during pregnancy poses significant diagnostic and therapeutic challenges for both the patient and the physician. The guidelines recommend that AYA women diagnosed with cancer during pregnancy require individualized treatment from a multidisciplinary team involving medical, surgical, and radiation oncologists, gynecologic oncologists, obstetricians, and perinatologists as appropriate.…”

“…172 Older-generation alkylating agents (eg, procarbazine, busulfan), thalidomide, lenalidomide, pomalidomide, and tretinoin are also considered teratogenic and are contraindicated during pregnancy. 166 The safety and efficacy of hormonal agents and targeted therapies have not yet been evaluated in well-controlled studies including pregnant women. [165][166][167][180][181][182] Currently, the use of such agents in pregnant women is not recommended.…”

“…The guidelines recommend that AYA women diagnosed with cancer during pregnancy require individualized treatment from a multidisciplinary team involving medical, surgical, and radiation oncologists, gynecologic oncologists, obstetricians, and perinatologists as appropriate. 157,166 Referral to tertiary cancer centers with expertise in the diagnosis of cancer during pregnancy and maternal-fetal medicine and knowledge of the physiologic changes that occur during pregnancy should be strongly encouraged.…”

“…169 In 2014, an international consensus panel composed of researchers and clinicians who are experts in treatment of cancer during pregnancy also developed guidelines for RT in women who are pregnant. 166 Chemotherapy should be avoided during the first trimester because of greater risk of teratogenic effects, which include major congenital malformations, impaired organ function, spontaneous abortions, and fetal death. 167,[170][171][172][173] Although the use of chemotherapy during the second and third trimesters has not been associated with significant teratogenic effects, it may be associated with low birth weight, preterm labor, and intrauterine growth restriction.…”