The treatment of Hodgkin's and non-Hodgkin's lymphoma in pregnancy

Abstract

Lymphoma is the fourth most frequent malignancy diagnosed during pregnancy, occurring in approximately 1:6000 of deliveries. Its occurrence may increase due to the current trend to postpone pregnancy until later in life and the suggested high incidence of AIDS-related non-Hodgkin's lymphoma in developing countries. The relatively rare occurrence of pregnancy-associated lymphoma precludes the conduction of large, prospective studies to examine diagnostic, management and outcome issues. Chemotherapy and radiotherapy during the first trimester are associated with increased risk of congenital malformations and this risk diminishes as pregnancy advances. In the vast majority of cases, when lymphoma is diagnosed during the first trimester, treatment with a standard chemotherapy regimen, following pregnancy termination should be recommended. In the rare patients at low risk, such as those with stage 1 Hodgkin's lymphoma or indolent non-Hodgkin's lymphoma, therapy can be delayed until the end of the first trimester and of embryogenesis while keeping the patients under close observation. When lymphoma is diagnosed during the second and third trimesters, evidence exists suggesting that full-dose chemotherapy can be administered safely without apparent increased risk of severe adverse fetal outcome.

Hematologic Malignancies in Pregnancy

“…According to the WHO-classification, we can divide them in three groups: indolent, aggressive and very aggressive. This disease is extremely rare in pregnancy, but the occurrence of NHL during pregnancy is expected to increase due not only to the currenttrend to postpone pregnancy, but the increasing incidence of HIV-associated lymphoma in developing countries (Pereg et al, 2007). NHL has an age dependent incidence pattern with a sharp increase in frequency starting in middle life (in contrast to HD).…”

“…R-CHOP) is safe and feasible, certainly in 2 nd and 3 rd trimester. Systemic therapy outside the first trimester (R-CHOP) seems to be safe for all forms of NHL (Pereg, 2007).…”

“…1. Proposal of a possible algorithm for the treatment of pregnancy associated HD (Pereg, 2007) www.intechopen.com…”

“…ABVD outside the first trimester seems feasible and safe. Patients with early stage HD diagnosed in the first trimester should be followed-up at short intervals for signs of disease progression without any treatment until the second trimester (Fisher et al,1996;Pereg et al, 2007). Offering single agent vinblastine along with steroids is another option (Nisce et al, 1986), yet congenital anomalies and spontaneous abortions have been described with this approach.…”

“…A large fraction of these tumors have an indolent course and thus could be safely watched during the course of pregnancy. In patients requiring active therapy, they could be offered regimens that have been shown to be safe in aggressive lymphomas (Nisce et al, 1986;Pereg et al, 2007).…”