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A Pregnancy Case of Primary Mediastinal Large B Cell Lymphoma with Superior Vena Cava Syndrome. Case Rep Obstet Gynecol 2022; 2021:3438230. [PMID: 34976421 PMCID: PMC8716195 DOI: 10.1155/2021/3438230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Primary mediastinal large B cell lymphoma (PMLBCL) is a subtype of non-Hodgkin's lymphoma which presents rarely in pregnancy. It is an aggressive tumour that is associated with symptoms of superior vena cava (SVC) compression and airway compromise such as dyspnoea, facial and arm swelling, cough, or chest pain. Timely diagnosis is imperative to optimising patient outcomes and reducing both maternal and fetal morbidity and mortality. We report a case of a 33-year-old woman diagnosed with PMLBCL who presented at 33-week gestation with SVC obstruction to 1 mm in diameter. After multidisciplinary team discussion regarding maternal and fetal implications of management options, we proceeded to a caesarean section and initiated chemotherapy postdelivery. Lower segment caesarean section was uncomplicated, and she underwent a cycle of R-CHOEP followed by 5 cycles of DA-EPOCH. Eighteen months since the completion of the chemotherapy, the disease remained in remission.
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Nara M, Kaga H, Saito M, Abe F, Saito A, Imaizumi C, Komatsuda A, Wakui H, Takahashi N. Successful Pregnancies in a Patient with Childhood-onset Steroid-dependent Nephrotic Syndrome during Rituximab Maintenance Therapy. Intern Med 2021; 60:2985-2989. [PMID: 33776000 PMCID: PMC8502647 DOI: 10.2169/internalmedicine.6633-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
There are an increasing number of reports on the safe use of rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, in pregnant women with hematological malignancies or refractory autoimmune diseases. In 2014, the use of RTX for patients with complicated steroid-dependent nephrotic syndrome (SDNS) was approved in Japan. We herein report a woman with childhood-onset complicated SDNS due to focal and segmental glomerulosclerosis, who had two successful pregnancies while receiving RTX maintenance therapy. No adverse complications were observed during the pregnancies, and she delivered healthy newborns. This case suggested that RTX may be used safely in pregnant women complicated with SDNS.
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Affiliation(s)
- Mizuho Nara
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Hajime Kaga
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Masaya Saito
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Fumito Abe
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Ayano Saito
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Chihiro Imaizumi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Atsushi Komatsuda
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
| | - Hideki Wakui
- Department of Life Science, Akita University Graduate School of Engineering Science, Japan
| | - Naoto Takahashi
- Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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Mormile I, Granata F, Punziano A, de Paulis A, Rossi FW. Immunosuppressive Treatment in Antiphospholipid Syndrome: Is It Worth It? Biomedicines 2021; 9:biomedicines9020132. [PMID: 33535377 PMCID: PMC7911562 DOI: 10.3390/biomedicines9020132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/18/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022] Open
Abstract
The antiphospholipid syndrome (APS) is characterized by the development of venous and/or arterial thrombosis and pregnancy morbidity in patients with persistent antiphospholipid antibodies (aPL). Catastrophic antiphospholipid syndrome (CAPS) is a life-threatening form of APS occurring in about 1% of cases. Lifelong anticoagulation with vitamin K antagonists remains the cornerstone of the therapy for thrombotic APS, but frequently the use of anticoagulation may be problematic due to the increased risk of bleeding, drug interactions, or comorbidities. Immunosuppressant drugs are widely used to treat several autoimmune conditions, in which their safety and effectiveness have been largely demonstrated. Similar evidence in the treatment of primary APS is limited to case reports or case series, and studies on a large scale lack. Immunomodulatory drugs may be an emerging tool in managing such particular situations, like refractory obstetrical complications, CAPS, or so-called APS non-criteria manifestations. In addition, immunomodulatory drugs may be useful in patients experiencing recurrent thromboembolic events despite optimized anticoagulant therapy. We did a comprehensive review of literature analyzing the possible role of immunomodulation in primary APS to provide a broad overview of potentially safe and effective target treatments for managing this devastating disease.
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Affiliation(s)
- Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (I.M.); (F.G.); (A.P.); (A.d.P.)
| | - Francescopaolo Granata
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (I.M.); (F.G.); (A.P.); (A.d.P.)
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (I.M.); (F.G.); (A.P.); (A.d.P.)
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (I.M.); (F.G.); (A.P.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (I.M.); (F.G.); (A.P.); (A.d.P.)
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-81-7464513
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Hashimoto Y, Omura H, Tokuyasu Y, Nakamoto S, Tanaka T. Successful Management of Primary Mediastinal Large B-cell Lymphoma during Pregnancy. Intern Med 2019; 58:3455-3459. [PMID: 31391392 PMCID: PMC6928502 DOI: 10.2169/internalmedicine.3129-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We experienced a pregnant woman with superior vena cava syndrome at 15 weeks of pregnancy who was diagnosed with primary mediastinal large B-cell lymphoma and given chemotherapy. In this case, the clinical courses of both the mother and infant were favorable without any serious complications because of close multidisciplinary cooperation. Based on a retrospective review of this case, the administration of CHOP-like regimens during the second and third trimesters appears relatively safe. Because pregnancy and continuation of pregnancy are rare in patients with hematopoietic malignancies, the accumulation of detailed information is important.
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Affiliation(s)
| | - Hiromi Omura
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
| | - Yusuke Tokuyasu
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Shu Nakamoto
- Department of Pathology, Tottori Prefectural Central Hospital, Japan
| | - Takayuki Tanaka
- Department of Hematology, Tottori Prefectural Central Hospital, Japan
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Reeder CF, Hambright AA, Fortner KB. Dyspnea in Pregnancy: A Case Report of a Third Trimester Mediastinal Mass in Pregnancy. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1536-1540. [PMID: 30591704 PMCID: PMC6322058 DOI: 10.12659/ajcr.910725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dyspnea in pregnancy is common and attributable to a variety of etiologies including normal physiology. The obstetric provider is challenged with distinguishing between physiologic versus pathologic dyspnea. CASE REPORT A 31-year-old G2 P1001 female at 34 weeks gestation presented with dyspnea, tachycardia, and inability to lie supine. Imaging revealed a large heterogeneous anterior mediastinal mass (14.8×11.5 cm). Multidisciplinary coordinated care led to diagnosis of B cell lymphoma, delivery via cesarean section under regional anesthesia in steep Trendelenberg position, followed by chemotherapy postpartum. CONCLUSIONS Dyspnea in pregnancy is common but might represent underlying pathology. While an obstetrician is knowledgeable of physiologic pregnancy changes, he or she should remain vigilant for underlying pathologic causes of dyspnea, including malignancy. Anterior mediastinal masses propose unique anesthetic challenges including respiratory impairment and cardiopulmonary collapse requiring collaborative care and planning.
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Affiliation(s)
- Callie Fox Reeder
- Department of Obstetrics and Gynecology, University of Tennessee, Knoxville, TN, USA
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Amante MA, Galagnara SJP, Ignacio J. Anaplastic large cell lymphoma in a pregnant Filipino woman successfully treated with prepartum and postpartum chemotherapy. BMJ Case Rep 2018; 2018:bcr-2018-225576. [PMID: 30209141 DOI: 10.1136/bcr-2018-225576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diagnosis of a malignancy during pregnancy presents a dilemma regarding the work-up and treatment of the patient. This report presents a 42-year-old woman on her 23rd week of pregnancy with multiple enlarging fungating violaceous skin masses. Biopsy of the dominant mass revealed anaplastic large cell lymphoma. Due to the progressive enlargement and increase in number of the masses, the patient was given two cycles of chemotherapy (doxorubicin, vincristine, cyclophosphamide and prednisone) before delivering a live baby boy via spontaneous vaginal delivery, Apgar 9.9, at 37 4/7 weeks. After delivery, she completed four more cycles of treatment. A full-body positron emission tomography scan done 2 months after the last chemotherapy showed no evidence of disease. The patient is doing well with no evidence of disease 9 months after treatment. Her baby is thriving and has no gross deformities and no developmental delays.
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Affiliation(s)
- Madelaine Amurao Amante
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sharon Jane Pingol Galagnara
- Section of Perinatology, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jorge Ignacio
- Section of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Buchholtz ML, Bücklein V, Brendel M, Paal M. Superior vena cava syndrome related to mediastinal lymphoma in late pregnancy: A case report. Case Rep Womens Health 2018; 19:e00065. [PMID: 30094193 PMCID: PMC6071368 DOI: 10.1016/j.crwh.2018.e00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/26/2022] Open
Abstract
We report the initial diagnosis in a 28-year-old nulliparous woman of a primary mediastinal B-cell lymphoma in late pregnancy. For several weeks the patient had had symptoms of mediastinal obstruction, such as dyspnea, cough, swelling of the face and upper limbs. However, these symptoms had been misattributed to the pregnancy and a common cold. Due to a rapid decline in the patient's cardiovascular performance, she was transferred to the closest perinatal center in the 34th week of pregnancy, whereupon a cesarean section was performed. The diagnosis of a primary mediastinal B-cell lymphoma was made postpartum from a biopsy. This case emphasizes the importance of timely antenatal investigation in pregnant women with symptoms consistent with mediastinal obstruction. Thoracic ultrasonography can be a valuable tool for the detection of tumor-associated pleural and pericardial effusions. The incidence of primary mediastinal B-cell lymphoma (PMBCL) is disproportionately high in women of reproductive age. The diagnosis is made at a median age of 35 years. Physiological changes during pregnancy can mask mediastinal malignancies since both conditions share similar clinical signs. Symptoms of mediastinal obstruction during pregnancy should therefore lead to immediate diagnostic workup. Thoracic ultrasound examination can aid in the diagnosis of lymphoma-associated pleural and pericardial effusions.
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Affiliation(s)
- M L Buchholtz
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
| | - V Bücklein
- Department of Internal Medicine III, University Hospital, LMU, Munich, Germany
| | - M Brendel
- Department of Nuclear Medicine, University Hospital, LMU, Munich, Germany
| | - M Paal
- Institute of Laboratory Medicine, University Hospital, LMU, Munich, Germany
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Das G, Damotte V, Gelfand JM, Bevan C, Cree BAC, Do L, Green AJ, Hauser SL, Bove R. Rituximab before and during pregnancy: A systematic review, and a case series in MS and NMOSD. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e453. [PMID: 29564373 PMCID: PMC5858951 DOI: 10.1212/nxi.0000000000000453] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/09/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the safety of rituximab treatment before and during pregnancy in women with MS and neuromyelitis optica spectrum disorders (NMOSDs) who may be at risk of relapses by performing a systematic literature review combined with a retrospective single-center case series. METHODS Studies were systematically identified in the PubMed, Google Scholar, and EMBASE using the key terms "pregnancy" and "rituximab"; 22 articles were included for review (>17,000 screened). Then, patients with MS and NMOSD from 1 center (University of California, San Francisco) exposed to rituximab before conception were identified through medical record review. RESULTS Systematic review: We identified 102 pregnancies with rituximab use within 6 months of conception: 78 resulted in live births and 12 in spontaneous abortions. Of 54 live births with reported gestational age, 31 occurred at term (37 weeks+) and 2 before 32 weeks. When checked, B-cell counts were low in 39% of newborns and normalized within 6 months. Case series: we identified 11 pregnancies (1 ongoing) in 10 women (7 MS and 3 NMOSD) treated with rituximab within 6 months of conception. All completed pregnancies resulted in term live births of healthy newborns (1 lost to follow-up at term). No maternal relapses occurred before/during pregnancy; 1 occurred postpartum (NMOSD). CONCLUSION No major safety signal was observed with rituximab use within 6 months of conception. Beyond the need for monitoring neonatal B cells, these observations support prospectively monitoring a larger patient cohort to determine whether rituximab may safely protect women with MS and NMOSD who are planning a pregnancy against relapses.
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Affiliation(s)
- Gitanjali Das
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Vincent Damotte
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Jeffrey M Gelfand
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Carolyn Bevan
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Bruce A C Cree
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Lynn Do
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Ari J Green
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Stephen L Hauser
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
| | - Riley Bove
- Department of Neurology, Weill Institute for the Neurosciences, University of California, San Francisco
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Abstract
Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of non-Hodgkin’s lymphoma, which occurs rarely in pregnancy. We present a case of a pregnant 22-year-old female who presented with syncope and dyspnea. Computed tomography (CT) chest showed an anterior mediastinal mass, and its biopsy showed PMBCL. Since she was in her second trimester, we decided to treat her with rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP). Our case emphasizes the safety of chemotherapy in the second and third trimesters, with good maternal and fetal outcomes.
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Affiliation(s)
- Sidra Khalid
- Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA
| | - Aariez Khalid
- Bachelor of Science (biomedical Science), University of Guelph
| | - Hamed Daw
- Department of Hematology and Oncology, Fairview Hospital, Cleveland Clinic, USA
| | - Praful Maroo
- Cardiology, Fairview Hospital, Cleveland Clinic, USA
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Kumagai M, Koishi W, Takahashi H, Suzuki K. Perioperative management of a pregnant patient with mediastinal tumor complicated by tuberculosis. JA Clin Rep 2017; 3:66. [PMID: 29457109 PMCID: PMC5804662 DOI: 10.1186/s40981-017-0136-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/06/2017] [Indexed: 11/29/2022] Open
Abstract
Mediastinal tumor in a pregnant woman, which had needed a multidisciplinary approach, was further complicated by tuberculosis. The clinical course of the current patient was very complicated. A 37-year-old female at 18 weeks of gestation with a mediastinal tumor was referred to our hospital due to dyspnea and orthopnea. The tumor compressed the left main bronchus causing bronchial stenosis. She was diagnosed with primary mediastinal large B-cell non-Hodgkin’s lymphoma. Delivery after 24 gestational weeks with ongoing chemotherapy was planned by a multidisciplinary team comprising obstetricians, anesthesiologists, neonatologists, and hematologists. Her symptoms improved with chemotherapy; however, she was later diagnosed with tuberculosis leading to chemotherapy interruption to treat tuberculosis. The following confirmation by negative sputum smear microscopy, an elective cesarean section with spinal anesthesia was performed at 33 weeks of gestation, and she safely delivered a female infant. At postoperative day 23, she died due to cardiopulmonary arrest, following an irreversible coma subsequent to brain metastasis of malignant lymphoma. The infant died of respiratory failure at postoperative day 18. This case illustrates several implications, such as the necessity of a thorough systemic examination and treatment approaches for mothers and neonates with suspected tuberculosis during the perioperative period, for considering similar cases with neoplasms.
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Affiliation(s)
- Motoi Kumagai
- Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023 Japan
| | - Wakana Koishi
- Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023 Japan
| | - Hiroya Takahashi
- Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023 Japan
| | - Kenji Suzuki
- Department of Anesthesiology, School of Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-0023 Japan
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Fiascone S, Datkhaeva I, Winer ES, Rizack T. Primary mediastinal large B-cell lymphoma in pregnancy. Leuk Lymphoma 2015; 57:240-3. [DOI: 10.3109/10428194.2015.1049168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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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.
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Abstract
OBJECTIVES Systematically review the literature assessing outcomes of acute myeloid leukemia (AML) treatment during pregnancy. DATA SOURCES A Pubmed literature search (January 1969 to June 2014) for articles written about AML and pregnancy, and bibliographies/citations of previously published reviews. STUDY SELECTION AND DATA EXTRACTION Articles written in the English language that administered active AML chemotherapy during pregnancy were included. DATA SYNTHESIS Eighty-five fetuses were exposed to chemotherapy from 83 mothers: 8 mothers began induction chemotherapy in the first trimester, 61 mothers in the second trimester, and 14 mothers in the third trimester. Chemotherapy resulted in more fetal deaths and spontaneous abortions during the first trimester (37.5%) compared with the second (9.7%) and third trimesters (0%). All cases included cytarabine; 47 fetuses were exposed to daunorubicin and 8 fetuses to idarubicin. The percentages of fetal defects and death for cytarabine and daunorubicin combinations were 8.5% and 6.4%, respectively. With cytarabine and idarubicin combinations, the percentages of fetal defects and death were 28.6% and 12.5%, respectively. Complete remission (CR) rates were 100%, 81%, and 67% in the first, second, and third trimesters. CONCLUSIONS Treatment during the second and third trimesters resulted in fewer fetal complications than the first trimester. However, delaying AML treatment may adversely affect the mother's outcomes. In the reported cases, induction during pregnancy resulted in CR rates comparable to that in nonpregnant patients. The choice of anthracycline is still unclear, but the decision should be made with careful consideration, weighing the outcomes for the mother and fetus.
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