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Parovichnikova EN, Troitskaya VV, Gavrilina OA, Sokolov AN, Kokhno AV, Klyasova GA, Kuzmina LA, Galstyan GM, Makhinya SA, Latyshkevich OA, Kaporskaya TS, Lapin VA, Chabaeva YA, Kulikov SM, Savchenko VG. The outcome of Ph-negative acute lymphoblastic leukemia presenting during pregnancy and treated on the Russian prospective multicenter trial RALL-2009. Leuk Res 2021; 104:106536. [PMID: 33676165 DOI: 10.1016/j.leukres.2021.106536] [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: 03/11/2020] [Revised: 11/09/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
We report the data on 15 women who presented with Ph-negative acute lymphoblastic leukemia (ALL) between Jan 2009 until Dec 2016 and who were treated on the prospective multicenter RALL-2009 clinical trial. A comparison of their outcome was made with 129 non-pregnant females who entered the study and were treated by the same schedule. 10-years OS for pregnant and non-pregnant women was 58.6 % (29.6 %-85.0 %) and 43.3 % (32.1 %-58.8 %), DFS was 46 % (15.2 %-78.8 %) and 51 % (39.7 %-64.6 %); probability of relapse was 49 % (16.6 %-83.3 %) and 40.3 % (27.3 %-53.4 %), respectively. Twelve born during the study children are well and alive with a median age 5 years 2 months (2 years - 9 years). Though small, our study has shown some specific features of ALL diagnosed during pregnancy (more T-cell ALL, higher initial WBC, later responses) and has shown that the long-term outcome of women with ALL treated while pregnant is equivalent to female control patients treated on the same protocol.
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Affiliation(s)
- Elena N Parovichnikova
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation.
| | - Vera V Troitskaya
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Olga A Gavrilina
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Andrey N Sokolov
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Alina V Kokhno
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Galina A Klyasova
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Larisa A Kuzmina
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Gennadiy M Galstyan
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Sergey A Makhinya
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Oleg A Latyshkevich
- Center of Family Planning and Reproduction of the Department of Health of Moscow Government, 117209, Sevastopolsky Prospect, 24A, Moscow, Russian Federation
| | - Tatyana S Kaporskaya
- Regional Clinical Hospital, Hematology Department, 664003, Karl Marx Street, 29, Irkutsk, Russian Federation
| | - Valery A Lapin
- Regional Clinical Hospital, Hematology Department, 150062, St. Yakovlevskaya, 7, Yaroslavl, Russian Federation
| | - Yulia A Chabaeva
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Sergey M Kulikov
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
| | - Valery G Savchenko
- National Research Center for Hematology, 125167, Novy Zykovsky proezd, 4, Moscow, Russian Federation
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Li A, Yang S, Zhang J, Qiao R. Establishment of reference intervals for complete blood count parameters during normal pregnancy in Beijing. J Clin Lab Anal 2017; 31:e22150. [PMID: 28105762 PMCID: PMC6816986 DOI: 10.1002/jcla.22150] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/23/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To observe the changes of complete blood count (CBC) parameters during pregnancy and establish appropriate reference intervals for healthy pregnant women. METHODS Healthy pregnant women took the blood tests at all trimesters. All blood samples were processed on Sysmex XE-2100. The following CBC parameters were analyzed: red blood cell count (RBC), hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), white blood cell count (WBC), and leukocyte differential count. Reference intervals were established using the 2.5th and 97.5th percentile of the distribution. RESULTS Complete blood count parameters showed dynamic changes during trimesters. RBC, Hb, Hct declined at trimester 1, reaching their lowest point at trimester 2, and began to rise again at trimester 3. WBC, neutrophil count (Neut), monocyte count (MONO), RDW, and PDW went up from trimester 1 to trimester 3. On the contrary, MCHC, lymphocyte count (LYMPH), PLT, and MPV gradually descended during pregnancy. There were statistical significances in all CBC parameters between pregnant women and normal women, regardless of the trimesters (P<.001). The median obtained were (normal vs pregnancy) as follows: RBC 4.50 vs 3.94×1012 /L, Hb 137 vs 120 g/L, WBC 5.71 vs 9.06×109 /L, LYMPH% 32.2 vs 18.0, Neut% 58.7 vs 75.0, and PLT 251 vs 202×109 /L. CONCLUSION The changes of CBC parameters during pregnancy are described, and reference intervals for Beijing pregnant women are demonstrated in this study.
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Affiliation(s)
- Aiwei Li
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
| | - Shuo Yang
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
| | - Jie Zhang
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
| | - Rui Qiao
- Department of Laboratory MedicinePeking University Third HospitalBeijingChina
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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.
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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
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Abstract
Life expectancy in sickle cell disease (SCD) has increased substantially and thus women with SCD are almost universally reaching child-bearing age. Studies on potential complications during pregnancy have generated mixed data; however, it is generally accepted that women with SCD are at higher risk for adverse pregnancy outcomes and maternal mortality. It is therefore critical that their care be provided by a team that includes a hematologist and a maternal-fetal medicine specialist. Despite the published risks, women with SCD are capable of successful pregnancy outcomes with proper education and well-coordinated multidisciplinary care. Further investigation is needed to standardize management.
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Affiliation(s)
- Biree Andemariam
- Division of Hematology-Oncology, Lea Center for Hematologic Disorders, Adult Sickle Cell Clinical and Research Center, University of Connecticut Health Center, Farmington, CT 06030, USA.
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Abdelhamid AE. Preterm infant with a catastrophic hemorrhagic-thromboembolic incident. Neonatology 2012; 102:293-9. [PMID: 22948176 DOI: 10.1159/000340030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 06/12/2012] [Indexed: 11/19/2022]
Abstract
Thrombotic disease of the newborn is uncommon but usually associated with serious morbidity and mortality. Although the operating mechanisms of coagulation and fibrinolysis are the same in all age groups, plasma concentrations of the two systems' components are significantly different in neonates compared to children and adults. This places neonates at greater risk for thrombosis that may rise considerably if a predisposing factor is present or a genetic or medical condition predisposing to thrombosis coexists. While marginal, the possibility of abnormal bleeding secondary to congenital prothrombotic disorders has been described. A significant association between thromboembolic/hemorrhagic disease in newborns and each of factor V(Leiden) and prothrombin G20210A mutations has been reported. Although not a frequent occurrence in adults and children, congenital 'multigenic' thrombophilia is well known. However, the combined heterozygote state of both mutations is perhaps underreported in preterm infants. We present a severely intrauterine growth-restricted preterm baby born to consanguineous parents. He had stroke as part of a generalized bleeding-thromboembolic incident caused by combined heterozygote mutation of factor V(Leiden) and prothrombin G20210A, each of which was then found in a heterozygote form in each of the 2 parents.
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