51
|
Pneumocystis Pneumonia in Non-HIV Pregnant Women Receiving Chemotherapy for Malignant Lymphoma: Two Case Reports. Case Rep Obstet Gynecol 2017; 2017:1073146. [PMID: 28932610 PMCID: PMC5592425 DOI: 10.1155/2017/1073146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/28/2017] [Accepted: 08/02/2017] [Indexed: 01/01/2023] Open
Abstract
Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection that sometimes occurs in immunocompromised patients with human immunodeficiency virus (HIV). Here, we report two extremely rare cases of PCP in non-HIV pregnant women who underwent chemotherapy for malignant lymphoma. Case 1 is a 34-year-old primigravida who was diagnosed with Hodgkin's lymphoma. She received ABVD chemotherapy and developed PCP at 37 weeks of gestation. After the onset of PCP, emergent cesarean section was performed due to a nonreassuring fetal status. Case 2 is a 31-year-old multigravida with diffuse large B-cell lymphoma who was administered R-CHOP chemotherapy. At 34 weeks of gestation, she complained of dyspnea and developed PCP. She delivered her baby vaginally immediately after the onset of symptoms. Both patients were treated with sulfamethoxazole-trimethoprim (ST) and recovered shortly thereafter. The babies' courses were also uneventful. PCP remains a serious cause of death, especially in non-HIV patients, and, therefore, appropriate prophylaxis and a prompt diagnosis are imperative.
Collapse
|
52
|
Fracchiolla NS, Sciumè M, Dambrosi F, Guidotti F, Ossola MW, Chidini G, Gianelli U, Merlo D, Cortelezzi A. Acute myeloid leukemia and pregnancy: clinical experience from a single center and a review of the literature. BMC Cancer 2017. [PMID: 28645262 PMCID: PMC5481954 DOI: 10.1186/s12885-017-3436-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Its clinical management remains a challenging therapeutic task both for patient and medical team, given to the therapy-attributable risks for mother and fetus and the connected counseling regarding pregnancy continuation. METHODS We provided a review of updated literature and a comprehensive description of five maternal/fetal outcomes of AML cases diagnosed concomitantly to pregnancy and treated at our Institution from 2006 to 2012. RESULTS Median age at AML diagnosis was 32 years (31-39). One diagnosis was performed in first trimester and the patient asked for therapeutic abortion before starting chemotherapy. Three cases were diagnosed in second/third trimester; in one case leukemia was diagnosed concomitantly with intrauterine fetal death, while the remaining two patients continued pregnancy and delivered a healthy baby by cesarean section. In only one of these two cases chemotherapy was performed during pregnancy (at 24 + 5 weeks) and consisted of a combination of daunorubicine and cytarabine. Therapy was well tolerated and daily fetus monitoring was performed. After completion of 30 weeks of gestation a cesarean section was carried out; the newborn had an Apgar score of 5/1'-7/5'-9/10', oxygen therapy was temporarily given and peripheral counts displayed transient mild leukopenia. One patient had diagnosis of myelodysplastic syndrome rapidly progressed to AML after delivery. Four out of the 5 described women are currently alive and disease-free. Three children were born and long-term follow-up has shown normal growth and development. CONCLUSIONS The treatment of AML occurring during pregnancy is challenging and therapeutic decisions should be taken individually for each patient. Consideration must be given both to the immediate health of mother and fetus and to long-term infant health. Our series confirmed the literature data: fetal toxicity of cytostatic therapy clusters during the first trimester; while chemotherapy can be administered safely during second/third trimester and combination of daunorubicin and cytarabine is recommended for induction.
Collapse
Affiliation(s)
- Nicola Stefano Fracchiolla
- Oncohematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy.
| | - Mariarita Sciumè
- Oncohematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesco Dambrosi
- Gynecology and Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Francesca Guidotti
- Oncohematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Manuela Wally Ossola
- Gynecology and Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Giovanna Chidini
- Anesthesiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Umberto Gianelli
- Division of Pathology, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Daniela Merlo
- Division of Pathology, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| | - Agostino Cortelezzi
- Oncohematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy
| |
Collapse
|
53
|
Lu D, Ludvigsson JF, Smedby KE, Fall K, Valdimarsdóttir U, Cnattingius S, Fang F. Maternal Cancer During Pregnancy and Risks of Stillbirth and Infant Mortality. J Clin Oncol 2017; 35:1522-1529. [DOI: 10.1200/jco.2016.69.9439] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To examine whether maternal cancer during pregnancy is associated with increased risks of stillbirth and infant mortality. Methods On the basis of nationwide health registers, we conducted a study of 3,947,215 singleton births in Sweden from 1973 through 2012. Exposure was defined as maternal cancer diagnosed during pregnancy (number of births = 984) or during the year after pregnancy (number of births = 2,723). We calculated incidence rate ratios (IRRs) for stillbirth and infant mortality, comparing exposed births to unexposed births. Small-for-gestational-age (SGA) and preterm births were examined as secondary outcomes. Results Maternal cancer diagnosed during pregnancy was positively associated with stillbirth (IRR, 2.5; 95% CI, 1.2 to 5.0), mainly stillbirths assessed as SGA (IRR, 4.9; 95% CI, 2.2 to 11.0), and with preterm SGA births (relative risk 3.0; 95% CI, 2.1 to 4.4). Positive associations of maternal cancer diagnosed during pregnancy or the year after pregnancy were noted for both neonatal mortality (deaths within 0 to 27 days; IRR, 2.7; 95% CI, 1.3 to 5.6 and IRR, 2.0; 95% CI, 1.2 to 3.2, respectively) and preterm birth (IRR, 5.8; 95% CI, 5.3 to 6.5 and IRR, 1.6; 95% CI, 1.4 to 1.8, respectively). The positive association with preterm birth was due to iatrogenic instead of spontaneous preterm birth. Preterm birth explained 89% of the association of maternal cancer during pregnancy with neonatal mortality. Conclusion Maternal cancer during pregnancy is associated with increased risks of rare but fatal outcomes, including stillbirth and neonatal mortality. This may be due to conditions associated with fetal growth restriction and iatrogenic preterm birth. Careful monitoring of fetal growth and cautious decision making on preterm delivery should therefore be reinforced.
Collapse
Affiliation(s)
- Donghao Lu
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Jonas F. Ludvigsson
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Karin E. Smedby
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Katja Fall
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Unnur Valdimarsdóttir
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Sven Cnattingius
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| | - Fang Fang
- Donghao Lu, Jonas F. Ludvigsson, Katja Fall, Unnur Valdimarsdóttir, and Fang Fang, Karolinska Institutet; Karin E. Smedby and Sven Cnattingius, Karolinska University Hospital, Stockholm; Jonas F. Ludvigsson, Örebro University Hospital; Katja Fall, Örebro University, Örebro, Sweden; Jonas F. Ludvigsson, University of Nottingham, Nottingham, United Kingdom; Jonas F. Ludvigsson, Columbia University College of Physicians and Surgeons, New York, NY; and Unnur Valdimarsdóttir, University of Iceland, Reykjavík,
| |
Collapse
|
54
|
Walsh EM, O'Kane GM, Cadoo KA, Graham DM, Korpanty GJ, Power DG, Carney DN. Is chemotherapy always required for cancer in pregnancy? An observational study. Ir J Med Sci 2017; 186:875-881. [PMID: 28477329 DOI: 10.1007/s11845-017-1602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/24/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer in pregnancy is relatively rare, but the incidence is increasing. Several studies show that cytotoxic agents are safe to use in pregnancy from the second trimester onwards. AIMS This study assesses the maternal and foetal outcomes of cancers diagnosed during pregnancy. In particular, it focuses on a subset of women who elected to defer systemic chemotherapy until after delivery. This study examines if all cancers need to be treated during pregnancy or if, in certain cases, treatment can be safely deferred until after full-term delivery. METHODS This is a retrospective observational study of women diagnosed with cancer during pregnancy in an Irish cancer centre over a 27-year period. All women diagnosed with cancer during pregnancy who were referred to the medical oncology department for consideration of chemotherapy were included in this study. Medical and pharmacy records were extensively reviewed. RESULTS Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology for consideration of systemic chemotherapy. Sixteen women (64%) commenced chemotherapy during pregnancy, seven women (28%) did not receive chemotherapy while pregnant, but commenced treatment immediately after delivery, and two (8%) did not receive any systemic chemotherapy at all. Of the seven women who commenced chemotherapy after delivery, six (85.7%) were diagnosed before 30/40 gestation. There were three cases of Hodgkin's lymphoma, two breast cancers and one ovarian cancer. After a median follow-up of 12 years, all six mothers remain disease-free. CONCLUSIONS This study identified a select cohort of patients that did not receive chemotherapy during pregnancy. There were no adverse outcomes to mothers due to delayed treatment.
Collapse
Affiliation(s)
- E M Walsh
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - G M O'Kane
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - K A Cadoo
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Breast Cancer Medicine Service, Memorial Sloan Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY, USA
| | - D M Graham
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.,Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - G J Korpanty
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital and Mercy University Hospital, Cork, Ireland
| | - D N Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
55
|
Marwah S, Gaikwad HS, Mohindra R, Sharma M. Up the Duff With Non-Hodgkin's Lymphoma: The Traumas and the Dilemmas. J Clin Diagn Res 2017; 11:QD03-QD05. [PMID: 28384939 DOI: 10.7860/jcdr/2017/23972.9221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/04/2016] [Indexed: 11/24/2022]
Abstract
Lymphoma is fourth most frequent malignancy diagnosed prenatally (~1:6000 cases), with Hodgkin's Lymphoma (HL) forming the major chunk. However, in recent times, there has been an increase in occurrence of Non-Hodgkin's Lymphoma (NHL) due to late child bearing age and high incidence of AIDS-related NHL in developing countries. Managing NHL in pregnancy involves intricate medical, ethical and psychological issues. Diagnostic and treatment delays may influence the prognosis for indolent cases. Seen the complexity of the management decisions associated with NHL, interdisciplinary and individualized approach becomes imperative for each woman. We present a case of 25-year-old G2P0010 at 32 weeks Period of Gestation (PoG) with right sided deep cervical lymphadenopathy, who was diagnosed as aggressive malignant NHL and was subsequently started on chemotherapy after confirmation of diagnosis and eventually had an optimal feto-maternal outcome. The critical appraisal of the accessible data, identification of controversies and unresolved issues and proposal of elucidations about varied facets of NHL in pregnancy are also provided.
Collapse
Affiliation(s)
- Sheeba Marwah
- Research Officer, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
| | - Harsha Shailesh Gaikwad
- Professor, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
| | - Ritin Mohindra
- Senior Resident, Department of Internal Medicine, VMMC and Safdarjung Hospital , New Delhi, India
| | - Manjula Sharma
- Professor and Consultant, Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital , New Delhi, India
| |
Collapse
|
56
|
Albano D, Patti C, Narese D, Mulè A, Midiri M, Galia M. Whole-body magnetic resonance for staging and response assessment of lymphoma in a pregnant woman treated with antenatal chemotherapy. BJR Case Rep 2017; 3:20150293. [PMID: 30363299 PMCID: PMC6159268 DOI: 10.1259/bjrcr.20150293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 06/04/2016] [Accepted: 09/22/2016] [Indexed: 11/05/2022] Open
|
57
|
Farge D, Bounameaux H, Bauersachs RM, Brenner B. Women, thrombosis, and cancer: A gender-specific analysis. Thromb Res 2017; 151 Suppl 1:S21-S29. [DOI: 10.1016/s0049-3848(17)30062-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
58
|
Gao DL, Fu QQ, Zhang TT, Sun L, Pan Y, Zhai QL. Occurrence of lymphoma in non-gonadal organ during pregnancy: a report on four cases and literature review. Cancer Biol Med 2016; 13:399-403. [PMID: 27807508 PMCID: PMC5069841 DOI: 10.20892/j.issn.2095-3941.2016.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lymphoma rarely occurs during pregnancy, making this condition difficult to define. Lymphomas that occur in reproductive organs during pregnancy exhibit unique clinical characteristics. Among the limited cases, non-Hodgkin's lymphoma (NHL) shows a considerably higher incidence rate than Hodgkin's lymphoma (HL); NHL also displays clinical characteristics, such as high aggressiveness, advanced stage, and poor outcome. This study reports on four cases of lymphomas in non-gonadal organs (HL,
n=2; NHL,
n=2) during pregnancy. The tumors rapidly progressed in all patients during pregnancy but remitted at the end of pregnancy and/or therapy. The two HL cases were nodular sclerosis classical HL and treated with chemotherapy after terminating the pregnancy. One of the NHL cases was primary cutaneous follicular center lymphoma, a B cell-derived indolent lymphoma. The patient was followed up without any therapy after terminating her pregnancy. The other case was a follicular lymphoma grade 3B, which was treated with chemotherapy after delivery. We also conducted a literature review of 165 lymphoma cases occurring during pregnancy reported from 1976 to 2013 to reveal the correlation between pregnancy and lymphoma progression. Immunohistochemistry studies were performed to determine the expression of estrogen/progesterone receptors (ER/PR), and ER was weakly positive and sporadic. We concluded that lymphomas occurring during pregnancy should be managed with a prompt and reasonable treatment. High estrogen level in maternal body may affect lymphoma progression.
Collapse
Affiliation(s)
- Da-Lin Gao
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Qian-Qian Fu
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Tian-Tian Zhang
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Lin Sun
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yi Pan
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Qiong-Li Zhai
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| |
Collapse
|
59
|
Odelia A, Erel J, Chava P, Yair H, Nadav S, Michael L, Irit A. Continuing dilemmas in the management of lymphoma during pregnancy: review of a 10-point case-based questionnaire. Int J Clin Oncol 2016; 22:190-199. [DOI: 10.1007/s10147-016-1036-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/27/2016] [Indexed: 01/18/2023]
|
60
|
Lavi N, Brenner B. Myeloproliferative neoplasms in pregnancy: ways to go. Br J Haematol 2016; 175:7-9. [PMID: 27601254 DOI: 10.1111/bjh.14290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Noa Lavi
- Department of Haematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Benjamin Brenner
- Department of Haematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel. .,Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
61
|
Farhadfar N, Cerquozzi S, Hessenauer MR, Litzow MR, Hogan WJ, Letendre L, Patnaik MM, Tefferi A, Gangat N. Acute leukemia in pregnancy: a single institution experience with 23 patients. Leuk Lymphoma 2016; 58:1052-1060. [PMID: 27562538 DOI: 10.1080/10428194.2016.1222379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Management of acute leukemia during pregnancy presents a considerable challenge. Herein, we review our experience of 23 patients diagnosed with acute leukemia; during pregnancy at the Mayo Clinic between 1962 and 2016. Ten (43.4%), seven (30.4%), and six (26.2%) patients were diagnosed in first, second, and third trimester, respectively. In approximately, 50% (n = 11) therapeutic terminations or spontaneous abortions occurred. Fifty percent (2/4) of patients diagnosed during either first or second trimester who delayed chemotherapy by greater than one week died during induction therapy. Eleven patients received chemotherapy while pregnant which led to four fetal losses and seven deliveries (five full-term and two preterm deliveries). No congenital malformations were reported. Eighteen patients (78%) achieved complete remission. At a median follow up of 55 months, seven patients (30%) remain alive. In summary, we provide a comprehensive description of maternal and fetal outcomes and insight into management of acute leukemia during pregnancy.
Collapse
Affiliation(s)
- Nosha Farhadfar
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Sonia Cerquozzi
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Michael R Hessenauer
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Mark R Litzow
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - William J Hogan
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Louis Letendre
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Mrinal M Patnaik
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Ayalew Tefferi
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Naseema Gangat
- a Division of Hematology , Mayo Clinic College of Medicine , Rochester , MN , USA
| |
Collapse
|
62
|
Paydas S. Management of hemopoietic neoplasias during pregnancy. Crit Rev Oncol Hematol 2016; 104:52-64. [DOI: 10.1016/j.critrevonc.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/12/2016] [Accepted: 05/10/2016] [Indexed: 11/30/2022] Open
|
63
|
Abstract
The diagnosis and management of hematologic malignancy during pregnancy is a significant challenge. This is due to both medical and ethical considerations regarding when and how to treat this special sub-group of patients. Recurring uncertainties remain around appropriate imaging techniques, timing and dosage of chemotherapy, and timing of delivery. In this article we examine and summarize current literature in this field to assist physicians in their understanding and management of this patient group. Special attention has been given to diagnostic and staging procedures, risks associated with chemotherapy at different stages of gestation, and chemotherapy-dose adaption during pregnancy. In addition, recommended guidelines for management of lymphoma, leukemia, and planning delivery are discussed. A multidisciplinary team approach is critical for patient care, as is shared decision making with the patient and family.
Collapse
|
64
|
Miyamoto S, Yamada M, Kasai Y, Miyauchi A, Andoh K. Anticancer drugs during pregnancy. Jpn J Clin Oncol 2016; 46:795-804. [PMID: 27284093 DOI: 10.1093/jjco/hyw073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/17/2016] [Indexed: 11/12/2022] Open
Abstract
Although cancer diagnoses during pregnancy are rare, they have been increasing with the rise in maternal age and are now a topic of international concern. In some cases, the administration of chemotherapy is unavoidable, though there is a relative paucity of evidence regarding the administration of anticancer drugs during pregnancy. As more cases have gradually accumulated and further research has been conducted, we are beginning to elucidate the appropriate timing for the administration of chemotherapy, the regimens that can be administered with relative safety, various drug options and the effects of these drugs on both the mother and fetus. However, new challenges have arisen, such as the effects of novel anticancer drugs and the desire to bear children during chemotherapy. In this review, we outline the effects of administering cytotoxic anticancer drugs and molecular targeted drugs to pregnant women on both the mother and fetus, as well as the issues regarding patients who desire to bear children while being treated with anticancer drugs.
Collapse
Affiliation(s)
- Shingo Miyamoto
- Department of Medical Oncology, Japanese Red Cross Medical Center, Shibuya, Tokyo
| | - Manabu Yamada
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Yasuyo Kasai
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Akito Miyauchi
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Kazumichi Andoh
- Department of Gynecology, Japanese Red Cross Medical Center, Shibuya, Tokyo, Japan
| |
Collapse
|
65
|
A mini review on pregnant mothers with cancer: A paradoxical coexistence. J Adv Res 2016; 7:559-63. [PMID: 27408757 PMCID: PMC4921772 DOI: 10.1016/j.jare.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/29/2016] [Accepted: 01/30/2016] [Indexed: 12/15/2022] Open
Abstract
The diagnosis of cancer during pregnancy at least in the Western world is a rare phenomenon, but this might be raised into the future due to late pregnancies in the modern societies. The coexistence of pregnancy and cancer implicates numerous medical, ethical, psychological and sometimes religious issues between the mother, the family and the treating physician. Breast, cervical cancer, melanoma and lymphoma are the most common malignancies diagnosed during pregnancy. Diagnostic or therapeutic irradiation requires careful application, whereas systemic chemotherapy is not allowed during the first trimester of pregnancy due to lethal or teratogenic effects as well as to congenital malformations. In some gestational cancers, tumor cells can invade the placenta or the fetus.
Collapse
|
66
|
Winckler P, Vanazzi A, Bozzo M, Scarfone G, Peccatori FA. Chronic lymphocytic leukaemia during pregnancy: management and thoughts. Ecancermedicalscience 2015; 9:592. [PMID: 26635896 PMCID: PMC4659706 DOI: 10.3332/ecancer.2015.592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Indexed: 12/25/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in the Western world. Despite this fact, its coexistence with pregnancy is extremely rare, with few cases reported in the literature. Given the rarity of this event, it is difficult to conduct large prospective trials to evaluate diagnostic, management, and outcome aspects. The existing evidence is limited to the few published cases and scarce data from reviews on haematological malignancies and pregnancy. Here, we report a case of a 36-year-old patient who had already finished treatment for CLL and was under surveillance when she got pregnant. We describe the evolution of the pregnancy and of the disease's behaviour as well as the oncological and obstetrical management. Being an indolent disease, CLL during pregnancy can be usually followed up without treatment, but infectious and autoimmune complications might have a significant impact on the pregnancy outcome. Therefore, pregnancy must be closely monitored in specialised centres.
Collapse
Affiliation(s)
- Patricia Winckler
- Serviço de Oncologia Médica, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Rua Professor Lima Basto, Lisboa 1700-023, Portugal
| | - Anna Vanazzi
- Division of Haematology Oncology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy
| | - Maddalena Bozzo
- Department of Obstetrics and Gynaecology, DMCO San Paolo, Via di Rudinì 8, Milan 20142, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology and Neonatology, IRCCS Fondazione Cà Granda, Ospedale Maggiore Policlinico, Via della Commenda 12, Milan 20122, Italy
| | - Fedro A Peccatori
- Fertility & Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435, Milan 20141, Italy
| |
Collapse
|
67
|
Jurczyszyn A, Olszewska-Szopa M, Vesole AS, Vesole DH, Siegel DS, Richardson PG, Paba-Prada C, Callander NS, Huras H, Skotnicki AB. Multiple Myeloma in Pregnancy--A Review of the Literature and a Case Series. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 16:e39-45. [PMID: 26847816 DOI: 10.1016/j.clml.2015.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
Abstract
Multiple myeloma (MM) typically affects older patients with a median age at diagnosis of 67 to 70 years and only 3% of cases are diagnosed before the age of 40. Moreover, MM is more common in men. Therefore, pregnancy rarely occurs in patients with MM and only 37 cases of MM in pregnancy have been reported in the literature. Herein we report an additional 5 cases. The diagnosis of MM might be problematic in this context because some of the symptoms and signs, such as back pain and anemia, can be attributed to pregnancy. Furthermore, if the patient wishes to continue her pregnancy, therapeutic options are currently limited. The list of agents that can be safely administered in pregnant women includes glucocorticoids. Moreover, any continuation of pregnancy has obvious long-term psychosocial repercussions for the patient and her family because of the currently incurable nature of MM. The reported cases of MM in pregnancy represent a spectrum of clinical manifestations. The selection of efficacious and safe treatments is challenging, especially if continuation of pregnancy is desired. Although some authors postulate that pregnancy might lead to progression of MM, data are limited and no consensus on this point has been reached.
Collapse
Affiliation(s)
- Artur Jurczyszyn
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Medical University, Wroclaw, Poland
| | - Adam S Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | - David H Vesole
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ and Georgetown University, Department of Medicine, Washington, DC
| | - David S Siegel
- John Theurer Cancer Center at Hackensack UMC, Hackensack, NJ
| | | | | | - Natalie S Callander
- Carbone Cancer Center, Department of Medicine, University of Wisconsin, Madison, WI
| | - Hubert Huras
- Department and Clinic of Obstetrics and Perinatology, Jagiellonian University, Medical College, Krakow, Poland
| | - Aleksander B Skotnicki
- Department and Clinic of Haematology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
68
|
Lishner M, Avivi I, Apperley JF, Dierickx D, Evens AM, Fumagalli M, Nulman I, Oduncu FS, Peccatori FA, Robinson S, Van Calsteren K, Vandenbroucke T, Van den Heuvel F, Amant F. Hematologic Malignancies in Pregnancy: Management Guidelines From an International Consensus Meeting. J Clin Oncol 2015; 34:501-8. [PMID: 26628463 DOI: 10.1200/jco.2015.62.4445] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The incidence of hematologic malignancies during pregnancy is 0.02%. However, this figure is increasing, as women delay conception until a later age. Systemic symptoms attributed to the development of a hematologic cancer may overlap with physiologic changes of pregnancy. A favorable prognosis is contingent upon early diagnosis and treatment. Therefore, a high index of suspicion is required by health care providers. Although timely, accurate diagnosis followed by appropriate staging is essential and should not be delayed due to pregnancy, management guidelines are lacking due to insufficient evidence-based research. Consequently, treatment is delayed, posing significant risks to maternal and fetal health, and potential pregnancy termination. This report provides guidelines for clinical management of hematologic cancers during the perinatal period, which were developed by a multidisciplinary team including an experienced hematologist/oncologist, a high-risk obstetrics specialist, a neonatologist, and experienced nurses, social workers, and psychologists. METHODS These guidelines were developed by experts in the field during the first International Consensus Meeting of Prenatal Hematologic Malignancies, which took place in Leuven, Belgium, on May 23, 2014. RESULTS AND CONCLUSION This consensus summary equips health care professionals with novel diagnostic and treatment methodologies that aim for optimal treatment of the mother, while protecting fetal and pediatric health.
Collapse
Affiliation(s)
- Michael Lishner
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium.
| | - Irit Avivi
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Jane F Apperley
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Daan Dierickx
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Andrew M Evens
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Monica Fumagalli
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Irena Nulman
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Fuat S Oduncu
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Fedro Alessandro Peccatori
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Susan Robinson
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Tineke Vandenbroucke
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van den Heuvel
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| | - Frederic Amant
- Michael Lishner, Meir Medical Center, Kfar Saba, and Tel Aviv University; Irit Avivi, Ichilov Medical Center, Tel Aviv, Israel; Jane F. Apperley, Hammersmith Hospital; Susan Robinson, Guy's and St Thomas' National Health Service Foundation Trust, London; Frank Van den Heuvel, University of Oxford, Oxford, United Kingdom; Andrew M. Evens, Tufts Medical Center, Boston, MA; Monica Fumagalli, University of Milan; Fedro Alessandro Peccatori, European Institute of Oncology, Milan, Italy; Irena Nulman, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada; Fuat S. Oduncu, University of Munich, Munich, Germany; Kristel Van Calsteren, University Hospital Gasthuisberg; Tineke Vandenbroucke and Frederic Amant, Katholieke Universiteit Leuven; Daan Dierickx, University of Leuven; and Tineke Vandenbroucke, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
69
|
Albright CM, Wenstrom KD. Malignancies in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 33:2-18. [PMID: 26542928 DOI: 10.1016/j.bpobgyn.2015.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/09/2015] [Indexed: 12/13/2022]
Abstract
Malignancy complicating pregnancy is fortunately rare, affecting one in 1000 to one in 1500 pregnancies. Optimal treatment involves balancing the benefit of treatment for the mother while minimizing harm to the fetus. This balance is dependent on the extent of the disease, the recommended course of treatment, and the gestational age at which treatment is considered. Both surgery and chemotherapy are generally safe in pregnancy, whereas radiation therapy is relatively contraindicated. Iatrogenic prematurity is the most common pregnancy complication, as infants are often delivered for maternal benefit. In general, however, survival does not differ from the nonpregnant population. These patients require a multidisciplinary approach for management with providers having experience in caring for these complex patients. The aim of this review was to provide an overview for obstetricians of the diagnosis and management of malignancy in pregnancy.
Collapse
Affiliation(s)
- Catherine M Albright
- Division of Maternal Fetal Medicine, Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| | - Katharine D Wenstrom
- Division of Maternal Fetal Medicine, Brown University, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905, USA.
| |
Collapse
|
70
|
Lambertini M, Kamal NS, Peccatori FA, Del Mastro L, Azim HA. Exploring the safety of chemotherapy for treating breast cancer during pregnancy. Expert Opin Drug Saf 2015; 14:1395-408. [DOI: 10.1517/14740338.2015.1061500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
71
|
Affiliation(s)
- Andrew K McGregor
- Department of Haematology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma Das-Gupta
- Centre for Clinical Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
72
|
Abstract
Although acute myeloid leukemia (AML) mostly occurs in older patients, it could be seen in women of childbearing age. It is therefore not surprising that in some patients, the management of AML will be complicated by a coexistent pregnancy. However, the association of leukemia and pregnancy is uncommon. Its incidence is estimated to be 1 in 75,000-100,000 pregnancies. During pregnancy, most leukemias are acute: two-thirds are myeloid and one-third are lymphoblastic. There is no standard approach for this clinical dilemma, in part because of variables such as the type of AML, the seriousness of the symptoms, and the patient's personal beliefs. In many cases, the diagnostic workup has to be altered because of the pregnancy, and often available treatments have varying risks to the fetus. While chemotherapy is reported to have some risks during the first trimester, it is admitted that it can be administered safely during the second and the third trimesters.
Collapse
Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud Hospital, Pierre Bénite, France
| |
Collapse
|
73
|
Abstract
Diagnosis of acute leukemia during pregnancy presents significant medical challenges. Pancytopenia, caused by bone marrow substitution with leukemic cells, impairs maternal and fetal health. Chemotherapeutic agents required to be immediately used to save the mother's life are likely to adversely affect fetal development and outcome, especially if administered at an early gestational stage. Patients diagnosed with acute leukemia during the first trimester are, therefore, recommended to undergo pregnancy termination. At later gestational stages, antileukemic therapy can be administered, although in this case, fetal outcome is still associated with increased incidence of growth restriction and loss. Special attention to the issue of future reproduction, adopting a personalized fertility preservation approach, is required. This article addresses these subjects, presenting women diagnosed with acute myeloid and acute promyelocytic leukemia in pregnancy. The rarity of this event, resulting in insufficient data, emphasizes the need for collaborative efforts to optimize management of this complicated clinical condition.
Collapse
Affiliation(s)
- Irit Avivi
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | | |
Collapse
|
74
|
Eyre TA, Lau IJ, Mackillop L, Collins GP. Management and controversies of classical Hodgkin lymphoma in pregnancy. Br J Haematol 2015; 169:613-30. [DOI: 10.1111/bjh.13327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Toby A. Eyre
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - I-Jun Lau
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| | - Lucy Mackillop
- Department of Obstetrics & Gynaecology; John Radcliffe Hospital; Oxford University Hospitals NHS Trust; Oxford UK
| | - Graham P. Collins
- Department of Haematology; Oxford University Hospitals NHS Trust; Oxford UK
| |
Collapse
|
75
|
Rady K, Wallace E, Seymour JF. An uncomplicated pregnancy in a woman with smoldering Waldenström macroglobulinemia. Leuk Lymphoma 2015; 56:2222-4. [PMID: 25641435 DOI: 10.3109/10428194.2014.984704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kirsty Rady
- Department of Haematology, Peter MacCallum Cancer Centre , East Melbourne, VIC , Australia
| | | | | |
Collapse
|
76
|
Therapeutic strategy and outcome of spine tumors in pregnancy: a report of 21 cases and literature review. Spine (Phila Pa 1976) 2015; 40:E146-53. [PMID: 25423305 DOI: 10.1097/brs.0000000000000719] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study was performed. OBJECTIVE To illustrate the characteristics of spine tumors during pregnancy and obtain better insight into therapeutic strategies of such tumors by analyzing 21 cases treated in Changzheng Hospital and reviewing previous reports in the literature. SUMMARY OF BACKGROUND DATA The concurrence of spine tumors and pregnancy is relatively rare. There are controversies over the treatment options for this disease, which increase the difficulty of the clinical treatment. METHODS Between 2002 and 2013, 21 pregnant patients were identified with spine tumors. Clinical data including symptoms, signs, treatment options, and obstetrical and neonatal outcomes were recorded and preserved. Clinical data and treatment efficacy were analyzed via medical record review. RESULTS The median age of the 21 patients was 28.87 years (interquartile range, 6.00 yr). Tumor types in this series were giant cell tumor (5 cases), hemangioma (5 cases), schwannoma (4 cases), eosinophilic granuloma (2 cases), neurofibroma (1 case), multiple myeloma (1 case), and with metastatic tumor (3 cases). Two patients underwent spine surgery during pregnancy and 8 patients accepted tumor resection immediately after delivery. Pregnancy termination occurred in 5 patients, whereas the rest of the patients smoothly gave birth to healthy babies including 3 premature infants. Two patients died and 2 patients experienced local recurrence during follow-up. CONCLUSION With close observation, it was found that most of pregnant patients with benign spine tumors could postpone surgery after delivery. Surgical treatment should be adopted during pregnancy when patients are with highly malignant tumor or experience a sharp deterioration and the guard of it is safer than radiotherapy and chemotherapy during pregnancy. LEVEL OF EVIDENCE 4.
Collapse
|
77
|
Cabañas-Perianes V, Macizo M, Salido E, Blanquer M, Araico F, Melero-Amor A, Garcia-Candel F, Muñoz-Garcia MI, Martinez-Villanueva M, Muñoz-Esparza C, Guzmán-Aroca F, Pérez-López R, Moraleda JM. 'Management multiple myeloma during pregnancy: a case report and review'. Hematol Oncol 2014; 34:108-114. [PMID: 25491088 DOI: 10.1002/hon.2184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 12/17/2022]
Abstract
Multiple myeloma (MM) is a hematologic neoplasm characterized by plasma tumor cell proliferation in the bone marrow. It's a rare malignancy before a 40-year-old and it is extremely uncommon during pregnancy. We report the case of a 37-year-old woman with a newly diagnosed IgG λ MM (Durie-Salmon stage IIIA, International Staging System II and good prognosis cytogenetic) at the 27th week of her pregnancy. Our management during pregnancy, the delivery, and initiation of anti-myeloma treatment with bortezomib, lenalidomide, and dexamethasone are published. There are a few reviews reporting the most common features and management of MM during pregnancy. We perform a comprehensive review of all 32 cases reported between 1965 and 2014 in which a MM was diagnosed during pregnancy including score, cytogenetic results, labor characteristics, and response to therapy. About 53% of pregnant women did not start treatment before partum. Cesarean section was the most common form of delivery (82%). About 88% of newborns were healthy, although most of them were premature (73%). Management of a MM diagnosed during pregnancy should be based on the presence of myeloma-related organ damage to secure survival of the mother without fetal adverse effects related to treatment. Serial fetal ultrasound may be helpful in order to avoid complications. The cesarean section may be preferred depending on maternal and fetus prognosis. Whole-body diffusion-weighted imaging minimal response could be an appropriate technique to discard plasmacytomas during pregnancy in critical situations such as the appearance of symptoms of spinal cord compression. Therapeutic choices should be agreed with the pregnant after a thorough discussion of the prognostic factors of the disease and the potential risk for the fetus and the patient. While awaiting partum, dexamethasone is a non-toxic treatment. Triple therapy including a proteasome inhibitor should be started quickly after delivery. Copyright © 2014 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Maribel Macizo
- Department of Obstetrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Eduardo Salido
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Miguel Blanquer
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Fernando Araico
- Department of Obstetrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Antonia Melero-Amor
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | | | | | - Carmen Muñoz-Esparza
- Department of Internal Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Raúl Pérez-López
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Jose Maria Moraleda
- Department of Hematology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| |
Collapse
|
78
|
Zaidi A, Johnson LM, Church CL, Gomez-Garcia WC, Popescu MI, Margolin JF, Ribeiro RC. Management of Concurrent Pregnancy and Acute Lymphoblastic Malignancy in Teenaged Patients: Two Illustrative Cases and Review of the Literature. J Adolesc Young Adult Oncol 2014; 3:160-175. [PMID: 25538861 DOI: 10.1089/jayao.2014.0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The usual age range of acute lymphoblastic malignancies (acute lymphoblastic leukemia and advanced-stage lymphoblastic lymphoma) includes teenagers and young adults (<22 years of age) and coincides with the age of fertility. Concurrence of acute lymphoblastic malignancy with pregnancy is therefore most likely to happen during the younger childbearing ages. However, the therapeutic challenges posed by the dual diagnosis of lymphoblastic malignancy and pregnancy have not specifically been studied in the context of age, and management guidelines for pregnant young patients are lacking. Inconsistency in defining the legal decision-making rights of pregnant teenaged patients adds a further level of complexity in this age group. Management of this challenging combination in the young patient therefore entails unique ethical considerations. Here we present two illustrative cases of teenage pregnancy complicated by acute lymphoblastic malignancy, review the available literature, and offer suggestions for the therapeutic management of such cases in adolescent and young adult patients. Importantly, practical management recommendations are provided in the context of clinical ethics principles that are universally applicable, including in developing countries, where the highest incidence of adolescent pregnancies has been documented.
Collapse
Affiliation(s)
- Alia Zaidi
- International Outreach Program, St. Jude Children's Research Hospital , Memphis, Tennessee. ; Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Liza-Marie Johnson
- Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Christopher L Church
- Division of General and Health Studies, Baptist College of Health Sciences , Memphis, Tennessee
| | - Wendy C Gomez-Garcia
- Department of Pediatric Hematology and Oncology, Hospital Infantil Dr. Robert Reid Cabral , Santo Domingo, Dominican Republic
| | - Marcela I Popescu
- Department of Pediatric Hematology and Oncology, St. Jude Tri-Cities Affiliate , Johnson City, Tennessee
| | - Judith F Margolin
- Department of Pediatric Hematology and Oncology, Texas Children's Hospital , Houston, Texas
| | - Raul C Ribeiro
- Department of Oncology, St. Jude Children's Research Hospital , Memphis, Tennessee
| |
Collapse
|
79
|
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy for diffuse large B-cell lymphoma in pregnancy may be associated with preterm birth. Obstet Gynecol Sci 2014; 57:526-9. [PMID: 25469343 PMCID: PMC4245348 DOI: 10.5468/ogs.2014.57.6.526] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/30/2014] [Accepted: 06/12/2014] [Indexed: 12/14/2022] Open
Abstract
Lymphoma, especially non-Hodgkin's lymphoma is extremely rare in pregnancy. A 24-year-old pregnant woman was diagnosed with diffuse large B-cell lymphoma (DLBCL), a subgroup of non-Hodgkin's lymphoma, at 24 weeks' gestation, and was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. After 4 cycles of R-CHOP, she delivered a healthy baby via cesarean section at 34 weeks and 5 days' gestation because of preterm contraction-related fetal distress. The patient was administered the remaining 2 cycles of R-CHOP after delivery. Follow-up magnetic resonance imaging and computed tomography showed complete remission. Here, we report a rare case of DLBCL successfully treated with R-CHOP chemotherapy during pregnancy, we also performed a systematic review of literature for similar cases. There were 3 earlier reports of R-CHOP treatment for DLBCL. All cases, including our case, resulted in preterm birth. Together, these findings suggest that R-CHOP chemotherapy for DLBCL in pregnancy may be associated with preterm birth.
Collapse
|
80
|
El-Messidi A, Patenaude V, Abenhaim HA. Incidence and outcomes of women with non-Hodgkin's lymphoma in pregnancy: A population-based study on 7.9 million births. J Obstet Gynaecol Res 2014; 41:582-9. [DOI: 10.1111/jog.12597] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/23/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Amira El-Messidi
- Department of Obstetrics and Gynecology; Royal Victoria Hospital; McGill University; Montreal Quebec Canada
| | - Valerie Patenaude
- Centre for Clinical Epidemiology and Community Studies; McGill University; Montreal Quebec Canada
| | - Haim Arie Abenhaim
- Centre for Clinical Epidemiology and Community Studies; McGill University; Montreal Quebec Canada
- Department of Obstetrics and Gynecology; Jewish General Hospital; McGill University; Montreal Quebec Canada
| |
Collapse
|
81
|
Oehler A, Shah S. Myopericarditis in a pregnant woman with acute promyelocytic leukemia. J Cardiol Cases 2014; 10:200-203. [PMID: 30534243 PMCID: PMC6279649 DOI: 10.1016/j.jccase.2014.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/16/2014] [Accepted: 07/15/2014] [Indexed: 12/14/2022] Open
Abstract
Acute promyelocytic leukemia (APL) is a form of acute leukemia with a characteristic translocation, t(15;17), and is considered a hematologic emergency, typically treated with all-trans retinoic acid and an anthracycline. We present the case of a young, gravid woman who was diagnosed with APL in the third trimester, initiated typical treatment, and suffered uncommon cardiac complications. .
Collapse
Affiliation(s)
| | - Shimoli Shah
- OHSU Knight Cardiovascular Institute, Portland, OR, USA
| |
Collapse
|
82
|
Basta P, Bak A, Roszkowski K. Cancer treatment in pregnant women. Contemp Oncol (Pozn) 2014; 19:354-60. [PMID: 26793018 PMCID: PMC4709394 DOI: 10.5114/wo.2014.46236] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 08/08/2014] [Indexed: 12/17/2022] Open
Abstract
In general, strategies for the treatment of cancer in pregnancy should not differ significantly from the treatment regimens in non-pregnant women. However, this is difficult due to either the effects of anticancer drugs on the developing foetus or the possibility of long-term complications after the exposure to drugs and radiation. The decision about the introduction and continuation of treatment in the event of pregnancy should be preceded by a detailed analysis of the potential benefits and risks. There are no data to suggest that pregnancy termination alters the biological behaviour of the tumour or patient prognosis in the presence of appropriate antineoplastic therapy. All patients should be given appropriate advice and informed that there are insufficient scientific data to determine any generally accepted consensus. It is very important to always respect the will of the patient, and the moral judgment of the physician should have no impact on the decisions taken by the woman. If the woman decides to undergo active treatment and maintain her pregnancy, it is necessary to carry out consultations with experts in the field appropriate to the type of cancer. This paper presents a basic review of the literature on the targeted therapies currently used in selected cancers diagnosed during pregnancy: breast cancer, cervical cancer, Hodgkin's disease, melanoma, thyroid cancer, ovarian cancer, and colorectal cancer.
Collapse
Affiliation(s)
- Pawel Basta
- I Department of Surgery, Jagiellonian University, Medical College, Krakow, Poland
- Department of Gynaecology and Oncology, Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | - Anna Bak
- Department of Radiotherapy, Lukaszczyk Oncology Centre, Bydgoszcz, Poland
| | | |
Collapse
|
83
|
Elterman KG, Meserve JR, Wadleigh M, Farber MK, Tsen LC. Management of Labor Analgesia in a Patient with Acute Myeloid Leukemia. ACTA ACUST UNITED AC 2014; 3:104-6. [DOI: 10.1213/xaa.0000000000000076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
84
|
Hamad N, Kliman D, Best OG, Caramins M, Hertzberg M, Lindeman R, Porter R, Mulligan SP. Chronic lymphocytic leukaemia, monoclonal B-lymphocytosis and pregnancy: five cases, a literature review and discussion of management. Br J Haematol 2014; 168:350-60. [PMID: 25256787 DOI: 10.1111/bjh.13134] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/04/2014] [Indexed: 11/27/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) occurs rarely with pregnancy and monoclonal B-Lymphocytosis (MBL) has not previously been described in this setting. CLL is predominantly a disease of the elderly and affects men twice as often as women and hence only an estimated 2% of patients are females of childbearing age. We identified only five reported cases of CLL in pregnancy in the literature. We describe two additional cases, plus three other women with CLL dealing with pregnancy-related decisions. We review the literature and discuss proposals for management and issues that arise in this relatively uncommon occurrence. In contrast to many other haematological malignancies where longer remissions are typically associated with a lower risk of relapse, most patients with CLL who require treatment will ultimately relapse with current therapy. This complex setting requires careful consideration and well informed patients to assist with decisions related to pregnancy.
Collapse
Affiliation(s)
- Nada Hamad
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia; Kolling Institute, University of Sydney, St Leonards, Sydney, NSW, Australia; Chronic Lymphocytic Leukaemia Australian Research Consortium (CLLARC), Sydney, NSW, Australia
| | | | | | | | | | | | | | | |
Collapse
|
85
|
|
86
|
Avivi I, Farbstein D, Brenner B, Horowitz NA. Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries. Blood Rev 2014; 28:213-20. [PMID: 25108745 DOI: 10.1016/j.blre.2014.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 12/15/2022]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) often present with systemic symptoms such as fatigue, shortness of breath and night sweats, mimicking pregnancy-related features which may result in delayed disease diagnosis. Furthermore, the wish to avoid investigational imaging, aiming to protect the fetus from radiation exposure, may lead to a further delay, which does not often result in significant changes in HL clinical nature and patient outcome. In contrast, a more aggressive behavior (i.e., advanced disease stage and reproductive organ involvement) of most NHL types diagnosed in pregnancy may require urgent therapeutic intervention to prevent disease progression. Current management of pregnancy-associated NHL depends on histological subtype of the disease, gestational stage at diagnosis and the urgency of treatment for a specific patient. Patients diagnosed with indolent lymphoma may often be just followed, whereas those presenting with aggressive or highly aggressive disease need to be urgently treated with chemoimmunotherapy, either after undergoing an elective pregnancy termination if diagnosed at an early gestational stage, or with pregnancy preservation, if diagnosed later. Supportive care of NHL is also important; however, granulocyte colony stimulating factor (G-CSF) which is commonly used outside of pregnancy, should be cautiously employed, considering its established teratogenicity in animals, though this is less proven in humans. In conclusion, given the paucity of studies prospectively evaluating the outcome of pregnant women with NHL, international efforts are warranted to elucidate critical issues and develop guidelines for the management of such patients.
Collapse
Affiliation(s)
- Irit Avivi
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Dan Farbstein
- Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| |
Collapse
|
87
|
de la Fuente J, Baruchel A, Biondi A, de Bont E, Dresse MF, Suttorp M, Millot F. Managing children with chronic myeloid leukaemia (CML): recommendations for the management of CML in children and young people up to the age of 18 years. Br J Haematol 2014; 167:33-47. [PMID: 24976289 DOI: 10.1111/bjh.12977] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic myeloid leukaemia in children and young people is a relatively rare form of leukaemia that shows increased incidence with age and some evidence suggests that the molecular basis differs from that in adults. Significant advances in targeted therapy with the development and use in children of tyrosine kinase inhibitors and the ability to monitor and understand the prognostic significance of minimal residual disease by standardized molecular techniques has shifted the management of this condition from bone marrow transplantation as the main therapeutic modality to individualized treatment for each patient based on achieving specific milestones. The physiological changes occurring during childhood, particularly those affecting growth and development and the long-term use of treatment, pose specific challenges in this age group, which we are only beginning to understand.
Collapse
|
88
|
Nakajima Y, Hattori Y, Ito S, Ohshima R, Kuwabara H, Machida S, Shirasugi Y, Miyazaki K, Sakai R, Tomita N, Ando K, Higashihara M, Ishigatsubo Y, Fujisawa S. Acute leukemia during pregnancy: an investigative survey of the past 11 years. Int J Lab Hematol 2014; 37:174-80. [DOI: 10.1111/ijlh.12256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/13/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Y. Nakajima
- Department of Hematology; Yokohama City University Medical Center; Yokohama Japan
| | - Y. Hattori
- Department of Hematology and Rheumatology; Fujisawa City Hospital; Yokohama Japan
| | - S. Ito
- Department of Internal Medicine and Clinical Immunology, Yokohama City University; Graduate School of Medicine; Yokohama Japan
| | - R. Ohshima
- Department of Hematology; Yokohama City University Medical Center; Yokohama Japan
| | - H. Kuwabara
- Department of Hematology; Yokohama City University Medical Center; Yokohama Japan
| | - S. Machida
- Department of Hematology-Oncology; Tokai University; Isehara Japan
| | - Y. Shirasugi
- Department of Hematology-Oncology; Tokai University; Isehara Japan
| | - K. Miyazaki
- Department of Hematology; Kitasato University School of Medicine; Sagamihara Japan
| | - R. Sakai
- Department of Hematology; Yokohama City University Medical Center; Yokohama Japan
| | - N. Tomita
- Department of Internal Medicine and Clinical Immunology, Yokohama City University; Graduate School of Medicine; Yokohama Japan
| | - K. Ando
- Department of Hematology-Oncology; Tokai University; Isehara Japan
| | - M. Higashihara
- Department of Hematology; Kitasato University School of Medicine; Sagamihara Japan
| | - Y. Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University; Graduate School of Medicine; Yokohama Japan
| | - S. Fujisawa
- Department of Hematology; Yokohama City University Medical Center; Yokohama Japan
| |
Collapse
|
89
|
Lavi N, Horowitz NA, Brenner B. An Update on the Management of Hematologic Malignancies in Pregnancy. WOMENS HEALTH 2014; 10:255-66. [DOI: 10.2217/whe.14.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hematological malignancies during pregnancy are rare, which results in the absence of large prospective studies. The diagnosis is often delayed due to the symptom similarity to those of pregnancy and the recommendation to avoid imaging studies during gestation. Management of hematological malignancies during pregnancy poses challenges both to the patient and the medical team, given the therapy-attributable risks for mother and fetus and the need to consider patient's preferences regarding pregnancy continuation. Chemotherapy during the first trimester is associated with an increased risk for fetal demise and congenital malformations, while these risks diminish as pregnancy progresses. We hereby present a review of updated literature on the management of hematologic malignancies (Hodgkin and non-Hodgkin lymphomas, acute leukemia, multiple myeloma, chronic myeloid leukemia and myeloproliferative neoplasms) during pregnancy.
Collapse
Affiliation(s)
- Noa Lavi
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Netanel A Horowitz
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Benjamin Brenner
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
90
|
|
91
|
Koh MB, Lao ZT, Rhodes E. Managing haematological disorders during pregnancy. Best Pract Res Clin Obstet Gynaecol 2013; 27:855-65. [DOI: 10.1016/j.bpobgyn.2013.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 08/06/2013] [Indexed: 01/06/2023]
|
92
|
Abstract
Leukemia in pregnancy remains a challenging therapeutic prospect. The prevalence is low at ∼1 in 10 000 pregnancies, and as a result data are limited to small retrospective series and case reports, rendering evidence-based recommendations for management strategies difficult. The management of the leukemias in pregnancy requires close collaboration with obstetric and neonatology colleagues as both the maternal and fetal outcomes must be taken into consideration. The decision to introduce or delay chemotherapy must be balanced against the impact on maternal and fetal survival and morbidity. Invariably, acute leukemia diagnosed in the first trimester necessitates intensive chemotherapy that is likely to induce fetal malformations. As delaying treatment in this situation is usually inappropriate, counseling with regard to termination of pregnancy is often essential. For chronic disease and acute leukemia diagnosed after the second trimester, therapeutic termination of the pregnancy is not inevitable and often, standard management approaches similar to those in nongravid patients can be used. Here, the management of the acute and chronic leukemias will be addressed.
Collapse
|
93
|
Gundelach T, Stuck D, Widschwendter P, Weiss JM, Janni W, Hancke K. Fertility preservation after caesarean delivery in a woman diagnosed with Morbus Hodgkin disease during pregnancy. J Assist Reprod Genet 2013; 31:51-3. [PMID: 24221910 DOI: 10.1007/s10815-013-0126-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/21/2013] [Indexed: 11/30/2022] Open
|
94
|
Evens AM, Advani R, Press OW, Lossos IS, Vose JM, Hernandez-Ilizaliturri FJ, Robinson BK, Otis S, Nadav Dagan L, Abdallah R, Kroll-Desrosiers A, Yarber JL, Sandoval J, Foyil K, Parker LM, Gordon LI, Blum KA, Flowers CR, Leonard JP, Habermann TM, Bartlett NL. Lymphoma Occurring During Pregnancy: Antenatal Therapy, Complications, and Maternal Survival in a Multicenter Analysis. J Clin Oncol 2013; 31:4132-9. [DOI: 10.1200/jco.2013.49.8220] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Lymphoma is the fourth most frequent cancer in pregnancy; however, current clinical practice is based largely on small series and case reports. Patients and Methods In a multicenter retrospective analysis, we examined treatment, complications, and outcomes for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) occurring during pregnancy. Results Among 90 patients (NHL, n = 50; HL, n = 40), median age was 30 years (range, 18 to 44 years) and median diagnosis occurred at 24 weeks gestation. Of patients with NHL, 52% had advanced-stage versus 25% of patients with HL (P = .01). Pregnancy was terminated in six patients. Among the other 84 patients, 28 (33%) had therapy deferred to postpartum; these patients were diagnosed at a median 30 weeks gestation. This compared with 56 patients (67%) who received antenatal therapy with median lymphoma diagnosis at 21 weeks (P < .001); 89% of these patients received combination chemotherapy. The most common preterm complication was induction of labor (33%). Gestation went to full term in 56% of patients with delivery occurring at a median of 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus antenatal therapy. At 41 months, 3-year progression-free survival (PFS) and overall survival (OS) for NHL were 53% and 82%, respectively, and 85% and 97%, respectively, for HL. On univariate analysis for NHL, radiotherapy predicted inferior PFS, and increased lactate dehydrogenase and poor Eastern Cooperative Oncology Group performance status (ECOG PS) portended worse OS. For HL patients, nulliparous status and “B” symptoms predicted inferior PFS. Conclusion Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.
Collapse
Affiliation(s)
- Andrew M. Evens
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Ranjana Advani
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Oliver W. Press
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Izidore S. Lossos
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Julie M. Vose
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Francisco J. Hernandez-Ilizaliturri
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Barrett K. Robinson
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Stavroula Otis
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Liat Nadav Dagan
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Ramsey Abdallah
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Aimee Kroll-Desrosiers
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Jessica L. Yarber
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Jose Sandoval
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Kelley Foyil
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Linda M. Parker
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Leo I. Gordon
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Kristie A. Blum
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Christopher R. Flowers
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - John P. Leonard
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Thomas M. Habermann
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| | - Nancy L. Bartlett
- Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J
| |
Collapse
|
95
|
Recent childbirth is an adverse prognostic factor in breast cancer and melanoma, but not in Hodgkin lymphoma. Eur J Cancer 2013; 49:3686-93. [DOI: 10.1016/j.ejca.2013.06.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/28/2013] [Accepted: 06/28/2013] [Indexed: 11/18/2022]
|
96
|
Hurley P, Linden MA, Peterson B, Blaes A. Burkitt lymphoma in pregnancy: two cases of successful treatment and continued fertility; with a review of the literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:e10-4. [PMID: 24021676 DOI: 10.1016/j.clml.2013.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/30/2013] [Accepted: 07/29/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Peter Hurley
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN.
| | | | | | | |
Collapse
|
97
|
Smith D, Stevens J, Quinn J, Cavenagh J, Ingram W, Yong K. Myeloma presenting during pregnancy. Hematol Oncol 2013; 32:52-5. [DOI: 10.1002/hon.2088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/09/2013] [Accepted: 06/24/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Dean Smith
- Clinical Haematology; University College Hospital; London UK
| | | | - John Quinn
- Haematology; Beaumont Hospital; Dublin Ireland
| | | | - Wendy Ingram
- Haematology; University Hospital of Wales; Cardiff Wales UK
| | - Kwee Yong
- Clinical Haematology; University College Hospital; London UK
| |
Collapse
|
98
|
Peccatori FA, Azim HA, Orecchia R, Hoekstra HJ, Pavlidis N, Kesic V, Pentheroudakis G. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 Suppl 6:vi160-70. [PMID: 23813932 DOI: 10.1093/annonc/mdt199] [Citation(s) in RCA: 470] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- F A Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Milan, Italy
| | | | | | | | | | | | | | | |
Collapse
|
99
|
Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review. Lancet Oncol 2013; 14:e275-82. [DOI: 10.1016/s1470-2045(12)70589-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
100
|
Brisou G, Bouafia-Sauvy F, Karlin L, Lebras L, Salles G, Coiffier B, Michallet AS. Pregnancy and multiple myeloma are not antinomic. Leuk Lymphoma 2013; 54:2738-41. [PMID: 23488659 DOI: 10.3109/10428194.2013.786069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Gabriel Brisou
- Department of Hematology, Centre Hospitalier Lyon Sud , Hospices Civils, Pierre Bénite , France
| | | | | | | | | | | | | |
Collapse
|