Management of Primary Mediastinal B-Cell Lymphoma in Pregnancy

Khalid, Sidra; Khalid, Aariez; Daw, Hamed; Maroo, Praful

doi:10.7759/cureus.2215

Cited by 5 publications

(6 citation statements)

References 4 publications

(8 reference statements)

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“…Follow-up positron emission tomography (PET) scan noted increased size in the mediastinal mass. She was treated with rituxan, ifofasmide, carboplatin, and etopo-side for 3 weeks followed by a stem cell transplantation [16]. Similar to our case, Shulman reported chemotherapy initiated following delivery after diagnosis made during pregnancy.…”

Section: Discussionsupporting

confidence: 65%

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Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

2018

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Patient: Female, 34Final Diagnosis: Primary mediastinal b cell lymphomaSymptoms: Cough • shortness of breathMedication: —Clinical Procedure: Cesarean deliverySpecialty: Obstetrics and GynecologyObjective:Rare co-existance of disease or pathologyBackground:Dyspnea in pregnancy is common and attributable to a variety of etiologies including normal physiology. The obstetric provider is challenged with distinguishing between physiologic versus pathologic dyspnea.Case Report:A 31-year-old G2 P1001 female at 34 weeks gestation presented with dyspnea, tachycardia, and inability to lie supine. Imaging revealed a large heterogeneous anterior mediastinal mass (14.8×11.5 cm). Multidisciplinary coordinated care led to diagnosis of B cell lymphoma, delivery via cesarean section under regional anesthesia in steep Trendelenberg position, followed by chemotherapy postpartum.Conclusions:Dyspnea in pregnancy is common but might represent underlying pathology. While an obstetrician is knowledgeable of physiologic pregnancy changes, he or she should remain vigilant for underlying pathologic causes of dyspnea, including malignancy. Anterior mediastinal masses propose unique anesthetic challenges including respiratory impairment and cardiopulmonary collapse requiring collaborative care and planning.

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Section: Discussionsupporting

confidence: 65%

“…Perez and Khalid demonstrated the safety of chemotherapy initiation for PMBCL diagnosed in the late first and second trimester [15,16]. In a Russian study, Mangasarova et al reported 8 cases of PMBCL in pregnancy that underwent chemotherapy during second and third trimesters.…”

Section: Discussionmentioning

confidence: 99%

Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

2018

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“…A PubMed search for English-language articles describing pregnant women with PMBL treated with chemotherapy revealed four cases, including ours (Table) (12-14). In many of these cases, patients received chemotherapy during the second trimester, presumably because they were symptomatic and could not remain untreated until delivery.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Primary Mediastinal Large B-cell Lymphoma during Pregnancy

et al. 2019

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We experienced a pregnant woman with superior vena cava syndrome at 15 weeks of pregnancy who was diagnosed with primary mediastinal large B-cell lymphoma and given chemotherapy. In this case, the clinical courses of both the mother and infant were favorable without any serious complications because of close multidisciplinary cooperation. Based on a retrospective review of this case, the administration of CHOP-like regimens during the second and third trimesters appears relatively safe. Because pregnancy and continuation of pregnancy are rare in patients with hematopoietic malignancies, the accumulation of detailed information is important.

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“…According to the European League against Rheumatism (EULAR) task force, due to insufficient documentation concerning fetal safety, rituximab should be discontinued before a planned pregnancy [ 121 ]. However, so far, there have been nine case reports of patients treated with rituximab during both the first and the second trimester of pregnancy, achieving life birth in all cases [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 ]. Six patients were affected by hematological neoplasms, and the remaining had idiopathic thrombocytopenic purpura, vasculitis, and Goodpasture syndrome [ 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 ].…”

Section: The Current Role Of Immunosuppressant Drugs In Antiphosphmentioning

confidence: 99%

Immunosuppressive Treatment in Antiphospholipid Syndrome: Is It Worth It?

et al. 2021

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The antiphospholipid syndrome (APS) is characterized by the development of venous and/or arterial thrombosis and pregnancy morbidity in patients with persistent antiphospholipid antibodies (aPL). Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening form of APS occurring in about 1% of cases. Lifelong anticoagulation with vitamin K antagonists remains the cornerstone of the therapy for thrombotic APS, but frequently the use of anticoagulation may be problematic due to the increased risk of bleeding, drug interactions, or comorbidities. Immunosuppressant drugs are widely used to treat several autoimmune conditions, in which their safety and effectiveness have been largely demonstrated. Similar evidence in the treatment of primary APS is limited to case reports or case series, and studies on a large scale lack. Immunomodulatory drugs may be an emerging tool in managing such particular situations, like refractory obstetrical complications, CAPS, or so-called APS non-criteria manifestations. In addition, immunomodulatory drugs may be useful in patients experiencing recurrent thromboembolic events despite optimized anticoagulant therapy. We did a comprehensive review of literature analyzing the possible role of immunomodulation in primary APS to provide a broad overview of potentially safe and effective target treatments for managing this devastating disease.

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Management of Primary Mediastinal B-Cell Lymphoma in Pregnancy

Cited by 5 publications

References 4 publications

Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy

Successful Management of Primary Mediastinal Large B-cell Lymphoma during Pregnancy

Immunosuppressive Treatment in Antiphospholipid Syndrome: Is It Worth It?

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