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Zhu D, Tang D, Chai X, Zhang G, Wang Y. Acute leukemia in pregnancy: a single institutional experience with 21 cases at 10 years and a review of the literature. Ann Med 2021; 53:567-575. [PMID: 33821734 PMCID: PMC8032338 DOI: 10.1080/07853890.2021.1908586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/19/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Acute leukemia (AL) occurring in pregnancy is extremely rare, and its treatment is a clinical dilemma. METHODS We retrospectively reviewed the medical records of our hospital from 2010 to 2019. RESULTS Twenty-one patients were diagnosed with AL during pregnancy. Of whom, eighteen had acute myeloid leukemia, and 3 had acute lymphoblastic leukemia. Six, eight and seven patients were diagnosed during the first, second, and third trimester, respectively. Six of the 21 patients experienced therapeutic abortion and 1 had spontaneous abortion, whereas 9 gave birth to healthy babies (4 through vaginal deliveries and 5 with Caesarean sections). Four babies had been exposed to chemotherapeutic agents, but no congenital malformations were observed. Sixteen patients received chemotherapy, while 4 patients died before chemotherapy and one was discharged after refusing chemotherapy. The complete remission rate of the 10 patients who began chemotherapy immediately after diagnosis was 80%, compared with 66.7% in the 6 patients who started chemotherapy after abortion or delivery. Three remain alive. CONCLUSIONS In general, initiation of chemotherapy as early as possible may increase the CR rate. Combined with literature data, we proposed that, for patients diagnosed in early and late stages of pregnancy (>30 weeks), elective termination or induced delivery before chemotherapy may be a good choice for better maternal (and fetal) outcome.KEY MESSAGESAcute leukaemia diagnosed in pregnancy is extremely rare, and its treatment is a clinical dilemma.In general, initiation of chemotherapy as early as possible may increase the CR rate.For patients who are diagnosed in the first trimester or late stage of pregnancy (>30 weeks), elective termination or induced delivery before starting chemotherapy may be a good choice for better maternal (and fetal) outcome.
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Affiliation(s)
- Dengqin Zhu
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Doudou Tang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Hunan Centre for Evidence-based Medicine, Central South University, Changsha, China
| | - Xiaoshan Chai
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Guangsen Zhang
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Molecular Hematology, Central South University, Changsha, China
| | - Yewei Wang
- Department of Hematology, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Molecular Hematology, Central South University, Changsha, China
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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 YW, Xu YF, Hu W, Qian SX, Chen C. Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review. Int J Hematol 2020; 112:487-495. [PMID: 32683599 DOI: 10.1007/s12185-020-02938-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
Management of acute myeloid leukemia during pregnancy (P-AML) is a challenging endeavor with limited evidence-based information available. To truly achieve the goal of improving P-AML patients, additional evidence-based research is necessary. We retrospectively reviewed cases of 17 patients diagnosed with P-AML, including seven for acute promyelocytic leukemia (APL) from January 2012 to June 2019. Among the non-APL, 90% patients (9/10) ended pregnancy prior to induction chemotherapy. The median intervals between diagnosis and start of chemotherapy were 5 days (range 1-14 days). Four patients elected to delay chemotherapy by more than one week. Of the seven APL patients, six received all-trans retinoic acid (ATRA) before the diagnostic molecular results. Five patients underwent cesarean sections (CS) and all newborns were alive (four preterm and one full-term deliveries). Overall, approximately 94% of the patients (16/17) are currently alive in remission. To treat P-AML patients in a safer manner, balancing the risk of progressing to advanced disease and proceeding with pregnancy is required. We consider a slight delay (less than 14 days) in the termination of pregnancy may not differ the prognosis to patients with non-APL. For APL, patients will benefit from prompt administration of ATRA for highly suspected cases.
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Affiliation(s)
- Yi-Wei Li
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 216 Huansha Road, Hangzhou, Zhejiang, 310006, People's Republic of China.,Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yang-Feng Xu
- Department of Obstetrics, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, HangZhou, People's Republic of China
| | - Wei Hu
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shen-Xian Qian
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 216 Huansha Road, Hangzhou, Zhejiang, 310006, People's Republic of China.
| | - Can Chen
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 216 Huansha Road, Hangzhou, Zhejiang, 310006, People's Republic of China.
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Santolaria A, Perales A, Montesinos P, Sanz MA. Acute Promyelocytic Leukemia during Pregnancy: A Systematic Review of the Literature. Cancers (Basel) 2020; 12:E968. [PMID: 32295152 PMCID: PMC7225915 DOI: 10.3390/cancers12040968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients received chemotherapy alone. Three patients were treated with arsenic-based regimens after delivery. Overall complete remission rate was 89%, with no statistically significant differences according to the type of induction and gestational age. During the first trimester, women were more likely to experience spontaneous and induced abortion compared to those during the second trimester (88% vs. 30%) (p < 0.0001), while only one patient diagnosed during the third trimester terminated in stillbirth. Twelve of 16 infants with neonatal complications had respiratory distress syndrome. Except two early deaths (Potter's syndrome and pulmonary hemorrhage), all neonates evolved favorably. This study confirms that gestational age does not affect the results in the mother, but is closely related to fetal viability. Our results may be useful for the process of decision making that requires the involvement of the patient, hematologist, obstetrician and neonatologist.
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Affiliation(s)
- Andrea Santolaria
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.); (A.P.)
| | - Alfredo Perales
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.); (A.P.)
- Department of Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, 28029 Madrid, Spain
| | - Miguel A. Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
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Verma V, Giri S, Manandhar S, Pathak R, Bhatt VR. Acute promyelocytic leukemia during pregnancy: a systematic analysis of outcome. Leuk Lymphoma 2015; 57:616-22. [PMID: 26110880 DOI: 10.3109/10428194.2015.1065977] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The outcomes of acute promyelocytic leukemia (APL) in pregnancy are largely unknown. The MEDLINE database was systematically searched to obtain 43 articles with 71 patients with new-onset APL during pregnancy. Induction therapy included various regimens of all-trans retinoic acid (ATRA), cytarabine, and anthracycline and resulted in a complete remission rate of 93%. Obstetric and fetal complications included pre-term deliveries (46%), spontaneous/therapeutic abortion/intrauterine death (33.3%) and other neonatal complications (25.9%). Mothers diagnosed in the first trimester were more likely to experience obstetric (p < 0.01) and fetal (p < 0.01) complications. To our knowledge, this is the largest systematic review of APL in pregnancy. The vast majority of APL patients in pregnancy may achieve remission with initial induction therapy. APL or its therapy in pregnancy, however, is associated with a high risk of fetal and obstetrical complications. The results of our study may help in patient counseling and informed decision-making.
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Affiliation(s)
- Vivek Verma
- a Department of Radiation Oncology , University of Nebraska Medical Center , Omaha , NE , USA
| | - Smith Giri
- b Department of Internal Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Samyak Manandhar
- c Department of Medicine , University of Pittsburgh Medical Center - Mercy Hospital , Pittsburgh , PA , USA
| | - Ranjan Pathak
- d Department of Internal Medicine , Reading Health System , West Reading , PA , USA
| | - Vijaya Raj Bhatt
- e Department of Internal Medicine , Division of Hematology/Oncology, University of Nebraska Medical Center , Omaha , NE , USA
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