Teratogenic effects in a case of maternal treatment for acute myelocytic leukaemia ? neonatal and infantile course

Artlich, A.; M�ller, Jens; Tschakaloff, Alexander; Schwinger, E.; Kruse, K.; Gortner, Ludwig

doi:10.1007/s004310050177

Cited by 4 publications

(5 citation statements)

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“…[15][16][17][18][19][20][21] Similarly, the reported overall fetal loss rates of approximately 20% in acute and chronic may be a function of the disease rather than the associated treatment. The actual CR rate in our group of patients with newly diagnosed AML who were being treated while pregnant was 86% (six of seven patients), while the CR rate in all the newly diagnosed AML cases was 69%.…”

Section: Discussionmentioning

confidence: 99%

Acute Leukemia during Pregnancy: A Single Institutional Experience with 17 Cases

Greenlund

Letendre

Tefferi

2001

Leukemia & Lymphoma

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We reviewed the medical records of 17 consecutive patients with concomitant acute leukemia and pregnancy seen at our institution over a 37-year period. Fifteen cases each were either newly diagnosed or classified as acute myeloid leukemia (AML). Seven diagnoses (41%) occurred in the first, 7 (41%) in the second, and 3 (18%) in the third trimester. In general, nine patients received chemotherapy while pregnant-eight in the second trimester and one in the third. The overall complete remission rate among the 13 patients with newly diagnosed AML was 69%, compared with 86% in those who were pregnant during chemotherapy. Long-term survival was documented in five of the nine complete responders. Three of four patients who elected to delay treatment until after delivery died within days of starting chemotherapy. Unintentional fetal loss occurred in four patients (29%), including two without exposure to chemotherapy. There were no instances of congenital malformation. The results from the current study confirm that pregnancy per se may not affect the outcome of chemotherapy in AML. In addition, it is suggested that treatment delays may compromise maternal outcome without improving pregnancy outcome.

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Section: Discussionmentioning

confidence: 99%

Acute Leukemia during Pregnancy: A Single Institutional Experience with 17 Cases

Greenlund

Letendre

Tefferi

2001

Leukemia & Lymphoma

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“…The measurement of 6-TGN levels in erythrocytes is only useful for determining patient compliance [45]. Contradictory results have been published about the potential teratogenic effects of 6-TG in case reports [46,47,48]. Therefore, the use of 6-TG during pregnancy or lactation should be avoided.…”

Section: A Critical Appraisal Of 6-thioguanine Treatment In Ibdmentioning

confidence: 99%

6-Thioguanine Treatment in Inflammatory Bowel Disease: A Critical Appraisal by a European 6-TG Working Party

et al. 2006

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Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6–12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity.

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“…Cytarabine is an antimetabolite, used extensively in the treatment of acute leukemia. Its employment during the first trimester may result in fetal malformations . Transient cytopenias, intrauterine fetal death, fetal growth restriction and neonatal death secondary to sepsis have been reported with its use during all trimesters though the risk is relatively small …”

Section: Case Ii: Recurrent Hl During Pregnancy; Risk Of Recurrence Dmentioning

confidence: 99%

The management of hodgkin lymphomas in pregnancies

Moshe

Bentur

Lishner

et al. 2017

European J of Haematology

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Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester.In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second-line chemotherapeutic regimens and timing of consolidation with high-dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient.

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Teratogenic effects in a case of maternal treatment for acute myelocytic leukaemia ? neonatal and infantile course

Cited by 4 publications

References 0 publications

Acute Leukemia during Pregnancy: A Single Institutional Experience with 17 Cases

Acute Leukemia during Pregnancy: A Single Institutional Experience with 17 Cases

6-Thioguanine Treatment in Inflammatory Bowel Disease: A Critical Appraisal by a European 6-TG Working Party

The management of hodgkin lymphomas in pregnancies

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