Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy

Triarico, Silvia; Rivetti, Serena; Capozza, Michele Antonio; Romano, Alberto; Maurizi, Palma; Attinà, Giorgio; Ruggiero, Antonio

doi:10.3390/cancers14133103

Cited by 12 publications

(8 citation statements)

References 149 publications

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“…Azathioprine, an immunosuppressive drug, is generally the treatment of choice for anterior uveitis, while cyclosporine-A is preferred for intermediate and posterior uveitis. Cyclophosphamide is typically avoided due to its potential fertility impacts (32). In our study, azathioprine was the most frequently utilized drug, with no patient receiving cyclophosphamide.…”

Section: Discussionmentioning

confidence: 77%

Characterizing Autoimmune Uveitis in Relation to Systemic Diseases: A Retrospective Study from a Syrian Tertiary Reference Center.

Kudsi,

Deeb,

Khalayli

et al. 2023

Preprint

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Background: Uveitis, a notable cause of severe visual impairment, is frequently characterized as infectious or non-infectious autoimmune uveitis (AU), the latter of which is commonly associated with younger individuals and systemic diseases. Despite the condition's widespread impact, there are substantial gaps in the comprehension of its pathogenesis, clinical presentation, and therapeutic response, particularly concerning systemic disease-associated uveitis. Aim of the Study: The current study aims to bridge these gaps through an extensive examination of demographic and clinical features in AU patients, thereby informing future research, therapeutic strategies, and improving patient outcomes. Methods: This retrospective observational study analyzed 87 patients with systemic disease-associated uveitis from January 2018 to December 2022 in Damascus, Syria. With diagnoses made using the Standardization of Uveitis Nomenclature Working Group Criteria, the study evaluated tailored treatment efficacy at the 24-month post-treatment mark, alongside comprehensive ophthalmic examinations, laboratory evaluations, and radiographic assessments. Results: In our study included 87 patients with Systemic Disease-Associated Autoimmune Uveitis (SDA-AU). Women represented 64.36% of this group, and the mean age at diagnosis was 43.8 for women and 39.8 for men. The most reported symptom was a painful red eye (52.87%). The onset of symptoms was sudden for 32.18% of patients, while 67.81% reported gradual development. Complications occurred in 33.33% of patients, including cataracts (41.37% of those with complications) and glaucoma (17.24%). Laboratory evaluations showed elevated inflammation markers in 66.66% of patients. Upon the 24-month assessment, 48.27% of patients achieved complete remission, 37.93% showed significant improvement, while disease worsened in 13.79% of cases. Conclusion: Our findings demonstrated that the presentation of autoimmune uveitis in this cohort frequently precedes the diagnosis of systemic diseases, affirming the vital role of an early and accurate diagnosis of uveitis for the detection of underlying systemic conditions. In conclusion, our study underlines the significance of a comprehensive and multidisciplinary approach in the management of SD-AU, leading to improved prognosis and quality of life for patients.

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Section: Discussionmentioning

confidence: 77%

Characterizing Autoimmune Uveitis in Relation to Systemic Diseases: A Retrospective Study from a Syrian Tertiary Reference Center.

Kudsi,

Deeb,

Khalayli

et al. 2023

Preprint

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“…The placenta functions as a biological interface between the mother and the foetus, providing nutrients and oxygen and acting as an immunologic barrier [ 86 , 87 ]. Under physiological conditions, maternal and foetal blood are functionally connected but separated by the placental barrier, which regulates the passage of xenobiotics, including antineoplastic agents [ 88 , 89 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis

Galante,

Cerbone,

Mannavola

et al. 2024

Diagnostics

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Objective: Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. Methods: This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. Results: A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. Conclusions: CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy.

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“…Developmental delay, cleft palate, ear defects, microcephaly, absence of digits, and hypoplastic limbs were described as teratogenic effects of cyclophosphamide exposure, especially during the first trimester 20 . Our newborn boy had none of these malformations.…”

Section: Discussionmentioning

confidence: 99%

Successful pregnancy after cyclophosphamide therapy for systemic lupus erythematosus: a case report

Drie,

Alsamman,

Tarcha

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and Importance: The use of cyclophosphamide in women of childbearing age with severe systemic lupus erythematosus is normally indicated. However, cyclophosphamide is generally avoided during pregnancy due to the risk of teratogenicity, especially since its effect on fetal survival is poorly understood. This is a case report of a lupus patient exposed to cyclophosphamide during pregnancy. Case Presentation: A 35-year-old woman with a history of lupus presented to our outpatient clinic in the 12th week of pregnancy for her 6th routine cyclophosphamide bolus. The fetal echocardiogram result with gynecology consultation was normal with the recommendation for a medical termination of pregnancy, which has been refused by the patient. Shared decision-making with the patient included a discussion of maternal risks of continuation of pregnancy in the setting of worsening systemic function and the fetal risks of definitive treatment with cyclophosphamide for a lupus flare and the patient decided to proceed with the pregnancy. Treatment with immunosuppressants, including azathioprine was initiated replacing cyclophosphamide with close monitoring of her and the fetus every month. Clinical Discussion: The first trimester of pregnancy seems to be particularly susceptible to fetal malformations, although CPA effects on fetuses in later stages of pregnancy are also reported occasionally. Nonetheless, its repercussions on fetal survival remain poorly comprehended. Conclusion: In conclusion, exposing pregnancy to cyclophosphamide could end with pregnancy loss. Based on our experience, the survival of the fetus is strongly in doubt when cyclophosphamide is required to treat lupus in the mother. However, in rare cases, it could be without complications.

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Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy

Cited by 12 publications

References 149 publications

Characterizing Autoimmune Uveitis in Relation to Systemic Diseases: A Retrospective Study from a Syrian Tertiary Reference Center.

Characterizing Autoimmune Uveitis in Relation to Systemic Diseases: A Retrospective Study from a Syrian Tertiary Reference Center.

Diagnostic, Management, and Neonatal Outcomes of Colorectal Cancer during Pregnancy: Two Case Reports, Systematic Review of Literature and Metanalysis

Successful pregnancy after cyclophosphamide therapy for systemic lupus erythematosus: a case report

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