Managing haematological malignancies in pregnant women

Ciaccio, Pietro R Di; Mills, Georgia; Tang, Cathering; Hamad, Nada

doi:10.1016/s2352-3026(21)00242-8

Cited by 6 publications

(9 citation statements)

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“…17 However, the majority of chemotherapeutics currently in everyday use (eg paclitaxel, doxorubicin, platinum analogs, cyclophosphamide, and vincristine), can be administered from 14 gestational weeks onward without consequences for the child, as it is protected by the placenta. 8,23 Therefore, administering chemotherapy during pregnancy should not be delayed,…”

Section: Discussionmentioning

confidence: 99%

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Milosevic,

Likic Ladjevic,

Dotlic

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionCancer complicating pregnancy is a rare but potentially life‐threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1‐year survival.Material and methodsThe study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival.ResultsMost malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20–40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1‐year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1‐year follow‐up (63.7%). Regression analysis identified the following predictors of favorable 1‐year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1‐year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section.ConclusionsIf the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.

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Section: Discussionmentioning

confidence: 99%

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Milosevic,

Likic Ladjevic,

Dotlic

et al. 2024

Acta Obstet Gynecol Scand

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“…The initial diagnosis of cancer during pregnancy can be challenging as signs and symptoms of cancer can be incorrectly attributed to the pregnancy [ 3 ]. Furthermore, there is limited evidence defining reference ranges in pregnant women for laboratory markers relevant to the recognition, diagnosis, and prognostication of cancers [ 35 ]. Finally, physicians may be hesitant to request investigations (e.g., imaging investigations) that may potentially impact the fetus [ 36 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy associated cancer, timing of birth and clinical decision making—a NSW data linkage study

Safi

Anazodo

et al. 2023

BMC Pregnancy Childbirth

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Background The incidence of pregnancy-associated cancer (PAC), comprising cancer diagnosed during pregnancy or within one year postpartum, is increasing. We investigated the obstetric management and outcomes of women with PAC and their babies. Methods A population-based observational study of all women who gave birth between 1994 and 2013 in New South Wales, Australia. Women were stratified into three groups: those diagnosed during pregnancy (gestational cancer group), those diagnosed within one year of giving birth (postpartum cancer group), and a no-PAC group. Generalized estimating equations were used to examine the association between PAC and adverse maternal and neonatal outcomes. Results One million seven hundred eighty-eight thousand four hundred fifty-onepregnancies were included—601 women (614 babies) were in the gestational cancer group, 1772 women (1816 babies) in the postpartum cancer group, and 1,786,078 women (1,813,292 babies) in the no-PAC group. The overall crude incidence of PAC was 132.7/100,000 women giving birth. The incidence of PAC increased significantly over the twenty-year study period from 93.5/100,000 in 1994 to 162.5/100,000 in 2013 (2.7% increase per year, 95% CI 1.9 – 3.4%, p-value < 0.001). This increase was independent of maternal age. The odds of serious maternal complications (such as acute abdomen, acute renal failure, and hysterectomy) were significantly higher in the gestational cancer group (adjusted odds ratio (AOR) 5.07, 95% CI 3.72 – 6.90) and the postpartum cancer group (AOR 1.55, 95% CI 1.16 – 2.09). There was no increased risk of perinatal mortality in babies born to women with PAC. However, babies of women with gestational cancer (AOR 8.96, 95% CI 6.96 – 11.53) or postpartum cancer (AOR 1.36, 95% CI 1.05 – 1.81) were more likely to be planned preterm birth. Furthermore, babies of women with gestational cancer had increased odds of a severe neonatal adverse outcome (AOR 3.13, 95% CI 2.52 – 4.35). Conclusion Women with PAC are more likely to have serious maternal complications. While their babies are not at increased risk of perinatal mortality, they are more likely to experience poorer perinatal outcomes associated with preterm birth. The higher rate of birth intervention among women with gestational cancers reflects the complexity of clinical decision-making in this context.

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“…These data included historical cases as far back as 1986 and 1969 respectively, although both diagnosis and treatment have evolved significantly since. All these reports are from North America and or Europe and are typically registry based or single‐centre experiences 8,15,16 …”

Section: Discussionmentioning

confidence: 99%

“…All these reports are from North America and or Europe and are typically registry based or single-centre experiences. 8,15,16 Unique to our study is the inclusion of women diagnosed with lymphoma up to 12 months postpartum, to account for the well-recognised antenatal phenomena of diagnostic delay and symptom mischaracterisation in pregnancy. The inclusion of these cases in the definition of cancer in pregnancy has been applied in registry and population studies for these reasons.…”

Section: Discussionmentioning

confidence: 99%

“…2,5,7 The evidence regarding the optimal care of pregnant women diagnosed with lymphoma is limited to modest case series and expert opinion. 8 It is critical to continue to collect and report data on optimal management of LIP, thus enhancing evidence-quality to inform clinical practice, particularly in an era of rapidly evolving therapies and standards of care. 8…”

Section: Introductionmentioning

confidence: 99%

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The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance

et al. 2023

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Summary Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B‐cell lymphoma (DLBCL; 11) and primary mediastinal B‐cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2‐ and 5‐year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2‐year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.

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Managing haematological malignancies in pregnant women

Cited by 6 publications

References 0 publications

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Pregnancy associated cancer, timing of birth and clinical decision making—a NSW data linkage study

The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance

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