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Ding J, Xiao Y, Fu J, Liu G, Huang S, Mo X. Pregnancy and neonatal outcomes in 25 pregnant women diagnosed with new-onset acute myeloid leukemia during pregnancy. Arch Gynecol Obstet 2024; 310:783-791. [PMID: 38466410 DOI: 10.1007/s00404-024-07402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The aim was to analyze the pregnancy and neonatal outcomes of pregnant women with new- onset acute myeloid leukemia (AML) diagnosed during pregnancy. METHODS In this retrospective study 25 pregnant women who were diagnosed with new-onset AML during pregnancy from January 2010 to January 2021 were enrolled. RESULTS A total of 4, 13 and 8 pregnant women with new-onset AML were diagnosed during the first, second, and third trimesters, respectively. Twelve of the 25 pregnant women underwent therapeutic abortion and 13 gave birth (9 preterm and 4 full-term newborns). The gestational age at initial clinical manifestations (13.4 ± 3.7 vs. 27.7 ± 5.6 weeks, P < 0.01) and diagnosis (16.9 ± 4.4 vs. 29.7 ± 5.5 weeks, P < 0.01) was lower in the pregnant women who underwent therapeutic abortion than in those who gave birth. Eighty-four percent (21/25) of the pregnant women with new-onset AML during pregnancy survived and were in remission and all the newborns were born alive. Three of the 13 newborns were exposed to chemotherapy, but no congenital malformations were observed. Eight newborns were admitted to the neonatal intensive care unit (NICU), and all recovered. The complete blood counts and biochemical examinations of the 8 newborns were normal. CONCLUSIONS New-onset AML during an earlier stage of pregnancy may increase the risk of poor pregnancy outcomes. The neonatal outcomes of pregnant women with new-onset AML during pregnancy are good with proper treatment.
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Affiliation(s)
- Jing Ding
- Department of Pediatrics, Peking University People's Hospital, Beijing, 100044, People's Republic of China
| | - YiHan Xiao
- Department of Pediatrics, Peking University People's Hospital, Beijing, 100044, People's Republic of China
| | - Jie Fu
- Department of Pediatrics, Peking University People's Hospital, Beijing, 100044, People's Republic of China
| | - Guoli Liu
- Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing, 100044, People's Republic of China
| | - Shanyamei Huang
- Peking University Institute of Hematology, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, 100044, People's Republic of China
| | - Xiaodong Mo
- Peking University Institute of Hematology, Peking University People's Hospital, No.11, Xizhimen South Street, Beijing, 100044, People's Republic of China.
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2
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Domanski K, Allswede M. The criminalisation of women's healthcare in the post-Dobbs era: an analysis of the anti-abortion trigger law statutes. EUR J CONTRACEP REPR 2023; 28:258-262. [PMID: 37590051 DOI: 10.1080/13625187.2023.2242546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
On 24 June 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organisation held that:'The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.'Since the ruling, thirteen states have enacted 'trigger laws' that restrict access to abortion except in specified circumstances, such as to save the life of the pregnant patient in a medical emergency. These laws not only inappropriately insert the State into the physician-patient relationship, but create an uncertain practice landscape for physicians by placing them at risk of criminal penalties. We illustrate the complexity of medical decision making for pregnant patients using examples from the case report literature, and discuss how leaving the definition of 'medical emergency' up to courts to decide will create a patchwork of restrictive and permissive standards that criminalises physicians and creates a 'political standard of care' that replaces evidence based medical care.
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Affiliation(s)
- Kristina Domanski
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Michael Allswede
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
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3
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Guan Z, Liang Y, Zhu Z, Yang A, Li S, Guo J, Wang F, Yang H, Zhang N, Wang X, Wang J. Cytosine arabinoside exposure induced cytotoxic effects and neural tube defects in mice and embryo stem cells. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115141. [PMID: 37320917 DOI: 10.1016/j.ecoenv.2023.115141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/16/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
Cytosine arabinoside (Ara-C) is one of the most widely used chemotherapeutic agents for hematological malignancies. The residues of Ara-C have been detected in wastewater and river water with increased usage and discharge. As the ability to cross the placenta and the teratogenicity at low ng/L levels, the toxic effects on pregnant women and infants have been concerned. The toxicity of Ara-C exposure on early embryonic neurodevelopment has not been fully elucidated. In this study, pregnant C57BL/6 mice were injected with different doses of Ara-C on Gestation day (GD) 7.5 and assessed on GD11.5 and GD13.5 to explore the neural developmental effects of Ara-C. HE staining, immunofluorescence, western blot, EdU assay, and flow cytometry were utilized to determine the toxic effects of Ara-C in vivo and in vitro. Our results showed that Ara-C (15-22.5 mg/kg body weight) induced the occurrence of neural tube defects (NTDs). The expression of PH3 was markedly reduced in embryos with Ara-C-induced NTDs, compared to the control group (P < 0.05). In contrast, cell apoptosis was markedly increased. Increased expression levels of GFAP and decreased Nestin were observed in the embryonic brain tissues in Ara-C induced NTDs. The level of β-catenin was also decreased on both GD11.5 and GD13.5. These results were confirmed in vitro using mouse Sv129 embryonic stem cells (mESC). Ara-C at a dose comparable to the environment level (0.05 nM) had cytotoxicity. Impaired Wnt/β-catenin signaling pathway is involved in Ara-C exposure induced imbalance between cell proliferation, apoptosis, and differentiation, which might contribute to Ara-C-induced occurrence of NTDs. Our data indicated the environmental concentration of Ara-C had cytotoxicity and that maternal exposure to Ara-C induced NTDs. These results might provide more information to understand the environmental toxic impact of Ara-C on neurodevelopment.
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Affiliation(s)
- Zhen Guan
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Yingchao Liang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Zhiqiang Zhu
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Aiyun Yang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Shen Li
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China
| | - Jin Guo
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Fang Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing 100020, China
| | - Huimin Yang
- Growth and Development Department, Capital Institute of Pediatrics, Beijing 100020, China
| | - Na Zhang
- Key Laboratory of Environmental and Viral Oncology, College of Life Science and Chemistry, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
| | - Xiuwei Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China.
| | - Jianhua Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing 100020, China.
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Kobayashi S, Biyajima K, Matsuzawa S, Sakai K, Kawakami F, Kawakami T, Nishina S, Sakai H, Fuseya C, Nakazawa H. Acute leukemias in pregnant women: Results of a retrospective study at a local tertiary-care hospital in Japan. EJHAEM 2023; 4:393-400. [PMID: 37206296 PMCID: PMC10188455 DOI: 10.1002/jha2.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 05/21/2023]
Abstract
Leukemia may rarely develop in a woman during pregnancy, posing clinical challenges to the patient, fetus, family, and medical staff managing malignancy and pregnancy. We retrospectively analyzed cases of pregnancy-associated leukemia consecutively diagnosed and treated at a local tertiary-care hospital in Nagano, Japan, over the past 20 years. Five cases were identified among 377,000 pregnancies in the area (one in every 75,000 pregnancies), all involving acute leukemia (three acute myelogenous leukemia [AML] and two acute lymphoblastic leukemia [ALL]). The cases were diagnosed in the first trimester (n = 1), second trimester (n = 3), or third trimester (n = 1). There were no apparent pregnancy-associated delays in diagnosing and treating the cases. Three patients underwent induction chemotherapy during pregnancy, two of whom eventually delivered healthy babies. One of the five patients chose abortion before chemotherapy initiation. Two cases showing high-risk features at the diagnosis (AML with an FLT3-ITD mutation [n = 1] and relapsed ALL [n = 1]) eventually died despite consolidative allogeneic hematopoietic stem cell transplantation. Our results suggested that patients with pregnancy-associated acute leukemia can be treated similarly to nonpregnant patients, although pregnancy imposes particular clinical challenges that should be resolved with multidisciplinary care.
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Affiliation(s)
- Shuhei Kobayashi
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Kyoko Biyajima
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Shuji Matsuzawa
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Kaoko Sakai
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Fumihiro Kawakami
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Toru Kawakami
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Sayaka Nishina
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Hitoshi Sakai
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
| | - Chiho Fuseya
- Department of Obstetrics and GynecologyShinshu University School of MedicineMatsumotoJapan
| | - Hideyuki Nakazawa
- Department of Hematology and Medical OncologyShinshu University School of MedicineMatsumotoJapan
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5
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Koutras A, Ntounis T, Fasoulakis Z, Papalios T, Pittokopitou S, Prokopakis I, Syllaios A, Valsamaki A, Chionis A, Symeonidis P, Samara AA, Pagkalos A, Pergialiotis V, Theodora M, Antsaklis P, Daskalakis G, Kontomanolis EN. Cancer Treatment and Immunotherapy during Pregnancy. Pharmaceutics 2022; 14:pharmaceutics14102080. [PMID: 36297515 PMCID: PMC9611953 DOI: 10.3390/pharmaceutics14102080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background/aim: Immunotherapy has, in recent years, witnessed an expansion in its indications for the treatment of cancer. Coupled with the fact that, nowadays, even more women choose to postpone parenthood, thus increasing their chances of having some kind of malignancy during pregnancy, more and more women are eligible for receiving immunotherapy during this period of their lives. The cases of cancer diagnosed during pregnancy is an ever-increasing trend nowadays. Materials and methods: The oncologists and clinicians treating women often face a range of ethical and therapeutic dilemmas due to the particularity of the patient’s conditions. The primary concern is the protection of the mother, firstly, and then the fetus (through adjustments to the various treatment regimens) if possible. Results and conclusions: Oncological drugs, radiation therapy, surgery, or a combination of all the above methods are selected, depending on the case. In this project, we studied the oncology drugs used for various types of gestational cancer, their appropriateness and timing, as well as their possible effects on the parent and embryo upon their administration. Various studies have shown that the administration of oncological drugs should be postponed until at least after the first trimester of pregnancy.
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Affiliation(s)
- Antonios Koutras
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
- Correspondence: ; Tel.: +30-694567622
| | - Thomas Ntounis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Theodoros Papalios
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Savia Pittokopitou
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Ioannis Prokopakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Athanasios Syllaios
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Asimina Valsamaki
- Department of Internal Medicine, Koutlimbaneio and Triantafylleio General Hospital of Larissa, Tsakalof Str. 1, 41221 Larisa, Greece
| | - Athanasios Chionis
- Department of Obstetrics and Gynecology, Laikon General Hospital of Athens, Agiou Thoma Str. 17, 11527 Athens, Greece
| | - Panagiotis Symeonidis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
| | - Athina A. Samara
- Department of Embryology, University General Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| | - Athanasios Pagkalos
- Department of Obstetrics and Gynecology, General Hospital of Xanthi, Neapoli, 67100 Xanthi, Greece
| | - Vasilios Pergialiotis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Panos Antsaklis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens ‘ALEXANDRA’, National and Kapodistrian University of Athens, Lourou and Vasilissis Sofias Ave, 11528 Athens, Greece
| | - Emmanuel N. Kontomanolis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 6th km Alexandroupolis–Makris, 68100 Alexandroupolis, Greece
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6
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Peng N, Liang MY, Jiang Q. [Diagnosis and treatment of acute leukemia during pregnancy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:82-86. [PMID: 35232003 PMCID: PMC8980671 DOI: 10.3760/cma.j.issn.0253-2727.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/15/2022]
Affiliation(s)
- N Peng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
| | - M Y Liang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Q Jiang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing 100044, China
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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: 9] [Impact Index Per Article: 3.0] [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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8
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Nowik CM, Gerrie AS, Wong J. Conservative Management of Presumed Fetal Anemia Secondary to Maternal Chemotherapy for Acute Myeloid Leukemia. AJP Rep 2021; 11:e137-e141. [PMID: 34925954 PMCID: PMC8674095 DOI: 10.1055/s-0041-1740561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Acute myeloid leukemia occurs rarely during pregnancy. When it is diagnosed remote from term, treatment in the form of daunorubicin plus cytarabine induction with consolidative cytarabine is typically undertaken after the first trimester. There is little data to guide fetal monitoring, in particular, whether and how often middle cerebral artery peak systolic velocity (MCA PSV) should be measured to screen for fetal anemia. Cytarabine may be particularly myelosuppressive to the fetus, but information pertaining to the management of this complication is also lacking in published literature. To our knowledge, we present the first case of presumed severe fetal anemia related to in utero exposure to chemotherapy that was managed conservatively with close sonographic monitoring, including serial measurement of MCA PSV. This case suggests that in the absence of hydrops fetalis or other signs of fetal decompensation, expectant management with ultrasound twice weekly, including MCA PSV, is appropriate. Ultrasounds may be decreased to weekly when MCA PSV does not suggest fetal anemia. Screening for fetal anemia can provide helpful information to guide the timing of chemotherapy administration and delivery. Key Points Chemotherapy for acute myeloid leukemia can cause fetal anemia.Fetal MCA PSV can be used to safely and effectively screen for fetal anemia.Observation of fetal anemia due to chemotherapy is reasonable, in the absence of hydrops.Monitoring of fetal MCA PSV can help guide timing of chemotherapy and delivery.
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Affiliation(s)
- Christina M. Nowik
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Division of Hematology and Medical Oncology, University of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jonathan Wong
- Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
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Namoju R, Chilaka NK. Alpha-lipoic acid ameliorates cytarabine-induced developmental anomalies in rat fetus. Hum Exp Toxicol 2020; 40:851-868. [PMID: 33225757 DOI: 10.1177/0960327120975114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cytarabine (Ara-C) is a nucleoside analogue used in the treatment of cancers and viral infections. It has teratogenic potential and causes a variety of birth defects in fetuses. Alpha-lipoic acid (ALA) is a natural antioxidant offers protection against the developmental toxicity induced by drug- or toxicant-exposure or pathological conditions. This study was aimed at evaluating the protective effect of ALA against Ara-C induced developmental toxicity in rat fetus. Pregnant rats divided into five groups and received normal saline, ALA200 mg/kg, Ara-C12.5 mg/kg, Ara-C25 mg/kg and, Ara-C25 mg/kg plus ALA200 mg/kg respectively from gestational day (GD) 8 to GD14 and sacrificed on GD21. Ara-C treatment led to a significant and dose-dependent decrease in food intake, weight gain, placental weight, and an increase in oxidative stress in pregnant rats. Further, the in-utero exposure to Ara-C led to an increase in fetal mortality, resorptions, oxidative stress, external morphological anomalies and limb abnormalities, and impaired ossification. Co-administration of ALA resulted in amelioration of the footprints of Ara-C induced toxicity in pregnant rats as well as the fetus. These findings indicate that the ALA supplementation offers protection against developmental toxicity caused by Ara-C prenatal exposure in rats.
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Affiliation(s)
- Ramanachary Namoju
- Department of Pharmacology, 78997GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India.,Department of Pharmacology, Bhaskar Pharmacy College, Jawaharlal Nehru Technical University, Hyderabad, Telangana, India
| | - Naga Kavitha Chilaka
- Department of Pharmacology, 78997GITAM Institute of Pharmacy, GITAM Deemed to be University, Vishakhapatnam, Andhra Pradesh, India
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10
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Patel SJ, Ajebo G, Kota V, Guddati AK. Analysis of outcomes in hospitalized pregnant patients with acute myeloid leukemia. AMERICAN JOURNAL OF BLOOD RESEARCH 2020; 10:68-75. [PMID: 32923085 PMCID: PMC7486487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/15/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There have been significant advances in the management of acute myeloid leukemia (AML) in the past decade. However, management of AML in the pregnant patient has been challenging as most interventions are contraindicated in pregnancy. Medical termination of pregnancy is advocated over chemotherapy in the first trimester as delaying chemotherapy could often be fatal. Chemotherapy during second and third trimesters may be provided with close surveillance of fetal abnormalities. The outcomes in these patients have not been systematically studied and have been limited to case reports and case series in medical literature. METHODS Patients hospitalized with a diagnosis of AML were identified using the International Classification of Disease (ICD-9) codes in the National Inpatient Sample database. This database is maintained by the Agency of Healthcare Research Quality under the United States Department of Health and Human Services. It represents 20% of all hospitalizations occurring in the United States every year. Amongst these AML patients, all patients who were pregnant were identified and their demographic information was extracted. Other details related to their hospitalization, hospital size, location, region and teaching status were also determined. The association of outcomes with common medical comorbidities was studied. Pregnancy related outcomes, mode of delivery and mortality rates were calculated for the 15 year time period. RESULTS During the time period of 2000 to 2014, 678942 hospitalizations involved AML patients of which 5076 were noted to be from pregnant women. The hospitalization trend gradually increased over these years and was noted to be the highest in the age group of 18-34 years. The highest hospitalization rates were noted in African American and Native American patient populations. Hypertension, hyperlipidemia, chronic kidney disease and smoking were noted to be more prevalent in pregnant women with AML. A majority of these patients had a Charlson's comorbidity index of 1-3. 3.5% of patients underwent medical termination of pregnancy, 16.25% suffered from pregnancy related complications, 0.6% suffered from puerperal infection, 4% of patients had normal vaginal delivery, 2.8% of patients had caesarian section and 5.7% of patient died. The rate of mortality was the highest in Native Americans followed by Caucasians. Multiple regression showed that odds of mortality have decreased from 2000 to 2015 and that a higher Charlson's comorbidity score was an independent predictor of mortality. CONCLUSIONS This is the first nationwide study to document the outcomes of pregnancy in hospitalized AML patients. AML in pregnancy is rare and this study shows that the mortality has been improving over the past 15 years. Notably, vaginal delivery has been more common than caesarian section in pregnant AML patients. Native Americans have high prevalence and high mortality rates, a likely result of healthcare disparity. Pregnant AML patients with high Charlson's comorbidity score may benefit from aggressive management of their comorbidities. Further studies are required to better characterize outcomes in pregnant women with AML.
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Affiliation(s)
- Sunny J Patel
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Germame Ajebo
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Vamsi Kota
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
| | - Achuta K Guddati
- Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA
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11
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Alrajhi AM, Alhazzani SA, Alajaji NM, Alnajjar FH, Alshehry NF, Tailor IK. The use of 5-azacytidine in pregnant patient with Acute Myeloid Leukemia (AML): a case report. BMC Pregnancy Childbirth 2019; 19:394. [PMID: 31672129 PMCID: PMC6822434 DOI: 10.1186/s12884-019-2522-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/20/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The management of Acute Myeloid Leukemia (AML) during pregnancy remains challenging as both the maternal and fetal outcomes should be considered. Several reports suggested that chemotherapy can be administered safely during the second and third trimester of pregnancy. However, the use of 5-azacytidine presents limitation due to lack of data. CASE PRESENTATION A 28-years-old woman in the 26th week of gestation diagnosed with FLT3/ITD-mutated AML, complete remission was induced by Daunorubicin and Cytarabine, and subsequently with 5-azacytidine (75 mg/m2 daily for 7 days) with no fetal hematological or toxicity issues. Fetal ultrasound showed no aberrant morphology. Fetal size below the 5th percentile with normal umbilical artery dopplers, normal middle cerebral artery dopplers and ductus venosus doppler. Three weeks post 5-azacytidine, the team determined the most appropriate time for delivery after balancing the risks of prematurity and prevention of disease relapse since patient in hematological remission. The patient underwent elective lower segment caesarian section and had a baby girl delivered at 35 weeks of gestation weighing 1670 g without apparent anomalies. CONCLUSION Treatment using 5-azacytadine during last trimester of pregnancy resulted in no major fetal and maternal complications. These findings concluded that 5-azacytadine during the third trimester of pregnancy seems to be safe however, potential risks of this agent should be considered.
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Affiliation(s)
| | - Sarah A Alhazzani
- Department of Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nouf M Alajaji
- Maternal Fetal Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fouad H Alnajjar
- Department of Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawal F Alshehry
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran K Tailor
- Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Nolan S, Czuzoj-Shulman N, Abenhaim HA. Obstetrical and newborn outcomes among women with acute leukemias in pregnancy: a population-based study. J Matern Fetal Neonatal Med 2019; 33:3514-3520. [PMID: 30773954 DOI: 10.1080/14767058.2019.1579188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose: Acute leukemias (ALs) are rare but aggressive malignancies. The goal of our study was to determine the incidence, obstetrical, and newborn outcomes of ALs in pregnancy.Materials and methods: We performed a retrospective population-based cohort study on all births reported in the Health-Care Cost and Utilization Project-Nationwide Inpatient Sample between 1999 and 2014. We calculated the incidence of ALs in pregnancy and conducted multivariate logistic regression to obtain adjusted odds ratios for various maternal and newborn outcomes among this population compared to a nonaffected one.Results: We identified 291 maternal cases of ALs among 14,513,587 births, yielding an incidence of 2.01 per 100,000 births over the 15-year study period. There were approximately twice as many diagnoses of acute myeloid leukemia (AML) as compared to acute lymphoid leukemia (ALL). After adjusting for differing baseline characteristics and maternal and fetal deaths, we found that pregnant women with ALs were more likely to experience post-partum hemorrhage, to suffer from disseminated intravascular coagulation (DIC), to require transfusions, to have wound complications, and to experience venous thromboembolism (VTEs). Maternal death, preterm delivery, and intrauterine fetal death (IUFD) were more common in pregnant women with ALs.Conclusion: The incidence of ALs in pregnancy appears to be greater than what was previously believed. As it is associated with several adverse maternal and fetal outcomes, affected patients should be cared for in tertiary care institutions with access to high-risk obstetrical specialists, hematologists, and neonatologists.
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Affiliation(s)
- Sabrina Nolan
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada
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Pregnancy associated acute leukemia: Single center experience. Cancer Treat Res Commun 2018; 16:53-58. [PMID: 31299003 DOI: 10.1016/j.ctarc.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Data regarding clinical characteristics, therapy, maternal and fetal outcomes of pregnancy-associated acute leukemia are limited. PATIENTS AND METHODS We herein, present the data of 27 pregnancy associated acute leukemia [18 acute myeloid leukemia (AML) and 9 acute lymphatic leukemia (ALL)]. Their data were compared to an age matched group of 75 non-pregnant acute leukemia patients admitted and treated during the same period [53 AML and 22 ALL]. RESULTS Complete remission rates, induction failure and induction deaths showed insignificant differences in pregnant versus non pregnant patients in both types of acute leukemia. Similarly, OS and DFS showed no significant difference between pregnant versus non pregnant patients in both types of acute leukemia. Cox regression analysis was conducted for prediction of OS and DFS in all the studied patients applying age, WBCs, BM blasts, LDH, cytogenetic abnormalities and pregnancy as covariates, Pregnancy was not considered as a risk factor for OS or PFS in univariate or multivariate analysis. CONCLUSION Our report to the best of our knowledge is the first to present direct evidence that pregnancy has no significant impact on outcome of acute leukemia compared to non-pregnant patients. These results are limited by the small number of cases and should be confirmed in a prospectively larger cohort of patients.
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