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Hagège J, Aguinaga L, Moatti H, Di Blasi R, Thieblemont C, Brice P, Renaud L. Management of Hodgkin Lymphoma during pregnancy, review of the literature and description of an homogenous expectative attitude associated with excellent outcome. Crit Rev Oncol Hematol 2024:104482. [PMID: 39151837 DOI: 10.1016/j.critrevonc.2024.104482] [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: 10/24/2023] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024] Open
Abstract
Hodgkin lymphoma (HL) occuring during pregnancy is a rare condition, and management relies on sparse literature. The specificity of pregnancy requires the clinician to take into account the clinical emergency, the stage of the lymphoma, the trimester of pregnancy, and the patient's choices. The main objective is twofold: to limit the risk of toxicity and adverse events for both mother and fetus, without reducing the chances of a successful outcome. Current literature data suggest that the use of ABVD-type polychemotherapy (adriamycin, bleomycin, vinblastine, dacarbazine) is associated with obstetrical events and long-term fetal toxicity. We report here the results of a homogeneous management considering wait-and-see, vinblastine monotherapy and ABVD polychemotherapy options. The outcomes in terms of obstetrical complications, response rate, and overall survival (100%) reinforce the idea that strategies that do not involve the use of multidrug therapy are possible and are associated with very good results.
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Affiliation(s)
- Joshua Hagège
- Hemato-oncologie, Hôpital Saint Louis, Paris, France
| | | | - Hannah Moatti
- Hemato-oncologie, Hôpital Saint Louis, Paris, France
| | | | | | - Pauline Brice
- Hemato-oncologie, Hôpital Saint Louis, Paris, France
| | - Loïc Renaud
- Hemato-oncologie, Hôpital Saint Louis, Paris, France.
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2
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Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review. BJOG 2023; 130:336-347. [PMID: 36424902 PMCID: PMC10107208 DOI: 10.1111/1471-0528.17347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The initial peak incidence of Hodgkin lymphoma (HL) occurs during reproductive years. OBJECTIVES Synthesise published literature on the relationship between HL and maternal and perinatal outcomes. SEARCH STRATEGY Systematic search of PubMed/Medline, Cochrane Library, Scopus, Embase and Science Direct from inception to June 2022, supplemented by hand-searching reference lists. SELECTION CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. Published studies containing original data were eligible. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and appraised study quality. Outcomes for pregnant women with a previous/current diagnosis of HL were compared separately with women never diagnosed with HL. Where data permitted, meta-analyses of odds ratios and proportions were performed. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. MAIN RESULTS Of the 5527 studies identified, 33 met the inclusion criteria. In the groups with HL before pregnancy and HL during pregnancy, adjusted odds ratios were not statistically significant for congenital malformation (aOR 1.7, 95% CI 0.9-3.1, and aOR 1.84, 95% CI 0.81-4.15, respectively), preterm birth (PTB) (aOR 0.99, 95% CI 0.65-1.51, and aOR 6.74, 95% CI 0.52-88.03, respectively) and miscarriage (aOR 0.78, 95% CI 0.55-1.10, and aOR 0.38, 95% CI 0.05-2.72, respectively). The aORs for all other outcomes were not statistically significant, except for blood transfusion (aOR 1.38, 95% CI 1.05-1.82) and venous thromboembolism (VTE) (aOR 7.93, 95% CI 2.97-21.22) in the group for HL during pregnancy. The proportion of anaemia was also increased in this group (69%, 95% CI 57%-80% vs 4%, 95% CI 4%-5%, respectively). The GRADE certainty of findings ranged from low to very low. CONCLUSIONS Rates of most adverse pregnancy outcomes among women with a previous/current HL diagnosis are not increased significantly compared with the general pregnant population. Women with HL diagnosed during pregnancy may have a higher PTB rate and increased likelihood of VTE, anaemia and blood transfusion; however, small study numbers and the low to very low GRADE certainty of findings preclude firm conclusions.
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Affiliation(s)
- Orla A Houlihan
- School of Public Health, University College Cork, Cork, Ireland
| | - Daire Buckley
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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3
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Transplacental Passage and Fetal Effects of Antineoplastic Treatment during Pregnancy. Cancers (Basel) 2022; 14:cancers14133103. [PMID: 35804875 PMCID: PMC9264939 DOI: 10.3390/cancers14133103] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this paper we perform an introduction about pregnancy-associated cancer (PAC) and transplacental passage of antineoplastic agents. Furthermore, we describe therapeutic use and potential toxic effects of chemotherapeutic drug (alkylating agents, antimetabolites agents, anthracyclines, topoisomerase inhibitors, antimitotic agents, actinomycin-D, bleomycin) and targeted agents during pregnancy. This manuscript may be a useful and practical guide for the management of PAC, which is a challenge for clinicians that have to consider alike maternal benefits and fetal potential risks correlated to the antineoplastic treatment. Abstract The incidence of PAC is relatively infrequent among pregnant women. However, it has gradually increased in recent years, becoming a challenging area for clinicians that should take into account in the same way maternal benefits and fetal potential risks correlated to the antineoplastic treatment. None of the antineoplastic drugs is completely risk-free during the pregnancy, the timing of exposure and transplacental transfer properties influence the toxicity of the fetus. Despite the lack of guidelines about the management of PAC, several studies have described the use and the potential fetal and neonatal adverse events of antineoplastic drugs during pregnancy. We provide a review of the available literature about the transplacental passage and fetal effects of chemotherapy and targeted agents, to guide the clinicians in the most appropriate choices for the management of PAC.
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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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5
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Moshe Y, Bentur OS, Lishner M, Avivi I. The management of hodgkin lymphomas in pregnancies. Eur J Haematol 2017; 99:385-391. [DOI: 10.1111/ejh.12956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Yakir Moshe
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Ohad Shimshon Bentur
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Michael Lishner
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Medicine A; Meir Medical Center; Kfar Saba Israel
| | - Irit Avivi
- Department of Hematology and Bone Marrow Transplantation; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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6
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Fruscio R, de Haan J, Van Calsteren K, Verheecke M, Mhallem M, Amant F. Ovarian cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2016; 41:108-117. [PMID: 28029502 DOI: 10.1016/j.bpobgyn.2016.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
Although the occurrence of ovarian masses in pregnancy is relatively common, the majority of them is functional and resolve spontaneously; nevertheless, ovarian cancer is the fifth most common malignancy diagnosed in pregnancy. If malignancy is suspected, treatment should be decided on the basis of gestational age, stage of the disease and patient preferences. In early stage, ovarian cancer surgery may be planned preferably after 16 weeks of pregnancy, and chemotherapy can be administered from the second trimester if indicated as in non-pregnant patients. In advanced-stage disease, when complete cytoreduction is not achievable, neoadjuvant chemotherapy could be administered even in pregnancy. Chemotherapy should be a combination of carboplatin and paclitaxel in epithelial ovarian cancer patients and a combination of cisplatin, vinblastin and bleomycin in non-epithelial ovarian cancer. The outcome of patients with ovarian cancer diagnosed in pregnancy is similar to non-pregnant patients, and stage of the disease is the most important prognostic factor.
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Affiliation(s)
- Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan Bicocca, San Gerardo Hospital, Monza, Italy.
| | - Jorine de Haan
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Department of Reproduction and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Magali Verheecke
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium
| | - Mina Mhallem
- Department of Obstetrics and Gynaecology, Cliniques Universitaires St. Luc, UCL, Brussels, Belgium
| | - Frederic Amant
- Department of Oncology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Division of Gynecologic Oncology, University Hospitals Leuven, Belgium; Center for Gynaecologic Oncology Amsterdam, Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, The Netherlands
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7
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Abstract
Hodgkin lymphoma (HL) presenting in patients with co-incidental advanced age, pregnancy, or human immunodeficiency virus (HIV) infection is uniquely challenging to manage. In this article we integrate recent evidence and clinical expertise to present recommendations for diagnosis and therapeutic management. Older patients with HL need to be carefully evaluated for comorbidies after which judicious choice of chemotherapy should minimize functional compromise. A pregnant patient with concurrent HL should be staged with minimal use of imaging requiring ionizing radiation and treated in an individualized manner optimally combining the strategies of treatment deferral when appropriate, use of single-agent vinblastine for symptomatic disease and reservation of multi-agent chemotherapy for the small minority of patients with aggressive clinical presentation. Treatment of HL coincident with HIV infection requires a combination of highly active anti-retroviral agents (HAART), standard multi-agent chemotherapy with meticulous attention to drug-drug interactions, and vigorous supportive care to ensure the best chance of cure.
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Affiliation(s)
- Veronika Bachanova
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA.
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8
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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.
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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
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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.
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Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Hematology Department, Lyon-Sud Hospital, Pierre Bénite, France
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10
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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.
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Affiliation(s)
- Irit Avivi
- Department of Hematology & Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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11
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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
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12
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Abstract
The peak incidence of Hodgkin lymphoma (HL) coincides with reproductive years, and as many as 3 % of all HL patients present with concurrent pregnancy. The management of a pregnant patient with HL requires a multidisciplinary approach combining expertise in medical oncology, high-risk obstetrics, and neonatology, as well as effective communication with the patient and her family. The goal is to optimize the mother's chance of a cure while allowing for delivery of a healthy child. A pregnant patient with HL should be staged by clinical examination and judicious use of non-radiation imaging such as ultrasound, balancing the need for accurate disease assessment with the need to minimize invasive procedures. The treatment strategy is individualized to the symptoms, lymphoma stage, gestational age and the patients' wishes. Therapeutic options include treatment deferral or single-agent vinblastine with reservation of multi-agent chemotherapy until the second or third trimester for the small minority of patients with aggressive clinical presentation.
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13
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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]
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14
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Del Pup L, Peccatori FA, Azim HA, Michieli M, Moioli M, Giorda G, Tirelli U, Berretta M. Obstetrical, fetal and postnatal effects of gestational antiblastic chemotherapy: how to counsel cancer patients. Int J Immunopathol Pharmacol 2013; 25:33S-46S. [PMID: 23092518 DOI: 10.1177/03946320120250s203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
At least one in a thousand pregnancies is complicated by cancer and, as the maternal age at pregnancy increases, numbers are growing. If chemotherapy cannot be postponed, both doctors and patients face complex medical and ethical issues. There is a conflict between optimal maternal therapy and fetal wellbeing. Treatment during the first trimester increases the risk of congenital malformations, spontaneous abortions and fetal death. Second and third trimester exposure is less risky, but it can cause intrauterine growth retardation and low birth weight. Other effects on pregnancy after the first trimester include premature birth, stillbirth, impaired functional development, myocardial toxicity and myelosuppression. Counseling and management of these cases are difficult, because literature is mostly represented by case reports or retrospective series while randomized prospective studies or guidelines are lacking. Moreover, personal experience is often scanty due to the rarity of the condition. This article reviews the available data regarding the different aspects of systemic treatment of cancer during pregnancy to help oncologist and obstetricians in counseling their patients and treat them accordingly.
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Affiliation(s)
- L Del Pup
- Division of Gynecological Oncology, National Cancer Institute, Aviano (PN), Italy.
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15
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Selig BP, Furr JR, Huey RW, Moran C, Alluri VN, Medders GR, Mumm CD, Hallford HG, Mulvihill JJ. Cancer chemotherapeutic agents as human teratogens. ACTA ACUST UNITED AC 2012; 94:626-50. [DOI: 10.1002/bdra.23063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 06/29/2012] [Accepted: 07/04/2012] [Indexed: 12/11/2022]
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A rare case of myeloid sarcoma presenting as an anorectal ulcer. Case Rep Med 2012; 2012:537278. [PMID: 22666268 PMCID: PMC3364052 DOI: 10.1155/2012/537278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/16/2012] [Indexed: 02/06/2023] Open
Abstract
Myeloid Sarcoma is a rare tumor composed of myeloblasts occurring at an extramedullary site like bones, or various soft tissues. Myeloid sarcoma may involve the gastrointestinal tract very rarely either solitarily, or occurring simultaneously with acute myeloid leukemia. Its diagnosis is challenging and needs biopsy and immunohistochemical staining. We are describing a case of myeloid sarcoma which presented as a painful anal ulcer mimicking an atypical fissure. Its appearance resembled crohn's disease on sigmoidoscopy. A biopsy of the ulcer along with histochemical staining led to the diagnosis of myeloid sarcoma. Our case demonstrates the need for aggressive evaluation of any common gastrointestinal complaint with an atypical presentation.
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Pagès C, Misset JL, de Kerviler E, Bavoux F, Fernandez H, Viguier M. [Melanoma during pregnancy]. Ann Dermatol Venereol 2012; 139:298-304; quiz 296-7, 306-7. [PMID: 22482486 DOI: 10.1016/j.annder.2012.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/30/2011] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
Affiliation(s)
- C Pagès
- Service de dermatologie, hôpital Saint-Louis, AP-HP, 1 avenue Claude-Vellefaux, Paris cedex 10, France
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18
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19
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[Melanocytic nevi, melanoma, and pregnancy]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:650-7. [PMID: 21530926 DOI: 10.1016/j.ad.2011.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 01/19/2011] [Accepted: 02/09/2011] [Indexed: 11/21/2022] Open
Abstract
Malignant melanoma is among the malignant tumors whose incidence has risen markedly in recent decades. For many years the medical community debated the potential adverse effects of female hormones (whether of exogenous or pregnancy-related endogenous origin), on melanocytic nevi and malignant melanoma. Given that women have been delaying pregnancy until their thirties or forties and that the incidence of malignant melanoma increases in those decades, the likelihood of this tumor developing during pregnancy has increased. Recent clinical and experimental evidence has suggested that pregnancy does not affect prognosis in malignant melanoma and that it does not seem to lead to significant changes in nevi. This review examines the relationship between malignant melanoma and hormonal and reproductive factors. Evidence was located by MEDLINE search (in PubMed and Ovid) for articles in English and Spanish for the period from 1966 to March 2010; additional sources were found through the reference lists of the identified articles.
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Azim HA, Pavlidis N, Peccatori FA. Treatment of the pregnant mother with cancer: A systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part II: Hematological tumors. Cancer Treat Rev 2010; 36:110-21. [DOI: 10.1016/j.ctrv.2009.11.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 11/09/2009] [Accepted: 11/15/2009] [Indexed: 11/28/2022]
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Affiliation(s)
- Cary Peterson
- Southeast Nebraska Hematology and Oncology Consultants, PC, Lincoln, NE
| | | | - Warren Sanger
- Human Genetics Laboratory, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE
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Abstract
Management of the pregnant patient with acute promyelocytic leukemia (APL) is a challenge. Immediate treatment of APL is critical, as it is an oncologic emergency, with a high risk of morbidity and mortality associated with disseminated intravascular coagulation. However, administration of chemotherapy and differentiating agents in pregnancy is controversial because of potential teratogenic effects. In addition, complications associated with APL, including retinoic acid syndrome, add to the complexity of management. To better understand how to manage this complex patient care situation, we searched the PubMed database (January 1972-May 2008) for English-language articles about maternal and fetal outcomes resulting from APL treatment during pregnancy. A total of 42 cases from 35 articles were identified: 12 first-trimester, 21 second-trimester, and 9 third-trimester cases. The most commonly administered agents were all-trans-retinoic acid (ATRA), anthracyclines, and antimetabolites. Complete remission was reported in 35 (83%) of 42 patients. Administration of ATRA or chemotherapy in the first trimester was associated with an increased risk of fetal malformations and spontaneous abortion, whereas administration in the second and third trimesters was associated with relatively favorable fetal outcomes. The overall treatment of the pregnant patient with APL should include a discussion about pregnancy termination, especially if APL is diagnosed in the first trimester. If the pregnancy is to continue, then the appropriate chemotherapy regimen needs to be determined. Frequent fetal monitoring, along with aggressive management of potential APL-related complications, is necessary to allow for optimal maternal and fetal outcomes.
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Affiliation(s)
- Daisy Yang
- Department of Pharmacy, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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23
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Pagès C, Robert C, Thomas L, Maubec E, Sassolas B, Granel-Brocard F, Chevreau C, De Raucourt S, Leccia MT, Fichet D, Khammari A, Boitier F, Stoebner PE, Dalac S, Celerier P, Aubin F, Viguier M. Management and outcome of metastatic melanoma during pregnancy. Br J Dermatol 2009; 162:274-81. [DOI: 10.1111/j.1365-2133.2009.09240.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ali R, Ozkalemkas F, Kimya Y, Koksal N, Ozkan H, Ozkocaman V, Hoyrazli A, Cetinkaya M, Tunali A. Acute leukemia and pregnancy. Leuk Res 2009; 33:e26-8. [DOI: 10.1016/j.leukres.2008.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/26/2022]
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Park TS, Lee ST, Kim JS, Song J, Lee KA, Kim SJ, Seok YM, Lee HJ, Han JH, Kim JK, Lee EY, Choi JR. Acute promyelocytic leukemia in early pregnancy with translocation t(15;17) and variant PML/RARA fusion transcripts. ACTA ACUST UNITED AC 2009; 188:48-51. [DOI: 10.1016/j.cancergencyto.2008.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 08/25/2008] [Accepted: 08/28/2008] [Indexed: 02/07/2023]
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Menezes J, Emerenciano M, Pimenta F, Filho GG, Magalhães IQ, Sant'ana M, Vasquez ML, Renault LZ, Pombo-De-Oliveira MS. Occurrence of Acute Myeloid Leukemia in Young Pregnant Women. Gulf J Oncolog 2008. [DOI: 10.4137/cmbd.s823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although acute leukaemia is rare in pregnancy its importance lies in its life-threatening potential, both to the child and the mother. The possibility of vertical transmission of leukemic cells increases the attention devoted to these patients and their offspring. Three cases of pregnant young women (15-17 years of age) with AML are presented. This series of cases is the first report where gene abnormalities such as ITD mutations of the FLT3 gene and AML1/ETO fusion genes were screened in pregnant AML patients and their babies, so far. Unfortunately, very poor outcomes have been associated to similar cases described in literature, and the same was true to the patients described herein. Although very speculative, we think that the timing and possible similar exposures would be involved in all cases.
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Affiliation(s)
- Juliane Menezes
- Programa de Hematologia e Oncologia Pediátricos, Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Mariana Emerenciano
- Programa de Hematologia e Oncologia Pediátricos, Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Flávia Pimenta
- Departamento Medicina Interna, Disciplina Hematologia UFPB, João Pessoa, PB, Brazil
| | | | - Isis Q. Magalhães
- Departamento de Hematologia / Oncologia Pediátrica SES-DF, Brasília, DF, Brazil
| | - Mariana Sant'ana
- Programa de Hematologia e Oncologia Pediátricos, Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Marina Lipkin Vasquez
- Centro de Transplante de Medula óssea—CEMO—Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Llana Zalcberg Renault
- Centro de Transplante de Medula óssea—CEMO—Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
| | - Maria S. Pombo-De-Oliveira
- Programa de Hematologia e Oncologia Pediátricos, Centro de Pesquisa, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
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Abstract
In summary, the management of women diagnosed with leukaemia in pregnancy needs an interdisciplinary approach, including a careful oncological work-up as well as close monitoring of the pregnancy until delivery and beyond. Patients with acute leukaemias normally must receive anti-leukaemic treatment at full dosage prior to delivery, except for selected women diagnosed very close to term. Treatment should be avoided in the first trimester. The prognosis of pregnant women with acute leukaemia corresponds to that of an age-matched and diagnosis-matched non-pregnant cohort of patients, provided appropriate treatment is given. If given as of the second trimester, the typical chemotherapy regimes used for acute leukaemias imply acceptable acute toxicities to the fetus, with a somewhat increased risk of premature birth or developmental retardation, but no clear evidence of late sequelae in children and adolescents who were exposed to cytostatic agents whilst in utero. In chronic leukaemias and MDS, treatment may often be delayed until after delivery. In CML targeted therapy with imatinib mesylate is safe as of the second trimester, and possibly even before. Obstetric care and monitoring of women with leukaemia are essential throughout the pregnancy to ensure the best possible outcome for mother and child.
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Affiliation(s)
- M F Fey
- Department of Medical Oncology, Inselspital and University, Bern, Switzerland
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Acute lymphoblastic leukemia during gestation. Med Oncol 2007; 25:190-3. [DOI: 10.1007/s12032-007-9024-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 10/23/2007] [Indexed: 11/25/2022]
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Morimatsu Y, Matsubara S, Hirose N, Ohkuchi A, Izumi A, Ozaki K, Ozawa K, Suzuki M. Acute promyelocytic leukemia: an unusual cause showing prolonged disseminated intravascular coagulation after placental abruption. Arch Gynecol Obstet 2007; 277:267-70. [PMID: 17713776 DOI: 10.1007/s00404-007-0444-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 08/06/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) caused by placental abruption usually improves rapidly after prompt delivery and adequate anti-DIC treatment. CASE A 30-year-old nulliparous woman suffered from placental abruption at the 25th week of pregnancy, and emergent cesarean section was done immediately. She exhibited DIC, which continued even after termination of the pregnancy and anti-DIC treatment. She also showed neutropenia. We closely observed her, and at the 58th day postpartum, blast cells appeared in the peripheral blood and she was diagnosed with acute promyelocytic leukemia (APL). Induction chemotherapy was done successfully. The close observation after delivery enabled us to make the prompt diagnosis/treatment, leading to the complete remission. CONCLUSION APL should be added to the list of differential diagnosis when DIC persists even after prompt delivery and appropriate anti-DIC treatment after placental abruption.
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Affiliation(s)
- Yukako Morimatsu
- Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan
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