Hodgkin Lymphoma in Pregnancy

Abstract

The peak incidence of Hodgkin lymphoma (HL) coincides with reproductive years, and as many as 3 % of all HL patients present with concurrent pregnancy. The management of a pregnant patient with HL requires a multidisciplinary approach combining expertise in medical oncology, high-risk obstetrics, and neonatology, as well as effective communication with the patient and her family. The goal is to optimize the mother’s chance of a cure while allowing for delivery of a healthy child. A pregnant patient with HL should be staged by clinical examination and judicious use of non-radiation imaging such as ultrasound, balancing the need for accurate disease assessment with the need to minimize invasive procedures. The treatment strategy is individualized to the symptoms, lymphoma stage, gestational age and the patients’ wishes. Therapeutic options include treatment deferral or single-agent vinblastine with reservation of multi-agent chemotherapy until the second or third trimester for the small minority of patients with aggressive clinical presentation.

Incidence and outcomes of women with Hodgkin’s lymphoma in pregnancy: a population-based study on 7.9 million births

“…Furthermore, inclusion of cases diagnosed before pregnancy or postpartum to the pooled sample of HL in pregnancy would also overestimate the true incidence. Recently, Bachanova and Connors reported that the largest clinical series of HL in pregnancy published in 1992, involved 48 women [4,17]. Our study is thereby important as it provides a large, unbiased population including 638 cases of HL in pregnancy with relatively stable incidence estimates over time.…”

“…Hodgkin's lymphoma represents the most common hematological malignancy complicating pregnancy, which is a function of the increased incidence of HL in the reproductive period, 15-34 years of age [4,7]. Smith et al also used the ICD-9 coding system to characterize the occurrence rates and nature of outcomes for cancer-associated obstetric deliveries, and found that HL in pregnancy was amongst the five most predominant malignancies [1,12].…”

“…Although we did not find data reporting the specific association of insurance status in the United States with HL, Halpern et al reported on nonHodgkin's lymphoma (NHL) and showed that a substantial portion of patients with NHL (43.9%) had private insurance plans relative to those under Medicaid (4.5%), and patients covered by Medicaid showed a significantly increased risk of advanced-stage disease at diagnosis [12]. It is known that the majority HL in pregnancy have early-stage disease with no or minimal symptoms [4]. This may explain the observed rates of private insurance relative to Medicaid or other plans.…”

Is Cytology Safest Modality Available in Armamentarium for Diagnosis of Hodgkin’s Lymphoma in Pregnancy?

“…It has a reported incidence ranging from 1 per 1,000 to 1 per 6,000 deliveries. [2] Since it is one of the most curable forms of lymphoma so FNAC plays a very important role in quick diagnosis and effective treatment of such cases. Radiological investigations have their limitations in pregnant females.…”

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

“…In fact, about 3% of HL patients present with concurrent pregnancy. These patients are diagnosed with same-stage disease as non-pregnant patients [10]. NHL is more problematic in this regard as patients may be diagnosed at later stages because pregnancy may masquerade symptoms [11].…”