Lymphoma and Leukemia during Pregnancy

ISSN 1745-5057 10.2217/WHE.13. 1 © 2013 Future Medicine Ltd Women's Health (2013) 9(2), 127–129 being pregnant could also be part of the biological features of pregnancy-related lymphoma, which is suggested to be characterized with highly aggressive histology and a strong predilection to the reproductive organs [12]. The management of lymphoma occurring during pregnancy ranges from a watch-and-wait approach, to an immediate need for therapeutic intervention depending on histological subtype and gestational stage at diagnosis [8]. Whereas most patients diagnosed with indolent, slow growing lymphoma (e.g., follicular lymphoma) can be watched carefully until delivery, some progress quite rapidly and need early initiation of single or combination chemotherapy [13,14]. Unless immediately required, chemotherapy should be deferred beyond first trimester due to its high teratogenicity. Pregnancy termination followed by conventional therapy should be seriously considered in this setting [14]. An alternative approach to multidrug chemotherapy, although less effective, but safer for the fetus, is the administration of an anti-CD20 monoclonal antibody rituximab as a single agent, which is highly effective in CD20 B-cell NHLs. A recent study on the outcome of 153 pregnancies occurring in women receiving rituximab (mostly administered in combination with other potentially teratogenic agents) [15] reported 90 live births (including 22 born prematurely and one who died at 6 weeks). Further findings included low incidence of anomalies (n = 2), a slightly higher likelihood for hematologic abnormalities, without significant increase in infections in these newborns, and a slightly elevated risk for neonatal infections (n = 4). Thus, the data indicate that rituximab may be relatively safe during pregnancy. Patients presenting either with aggressive or highly aggressive forms of NHL (diffuse large cell and Burkitt lymphoma, respectively) should be treated promptly, employing therapeutic regimens known to be most appropriate for their specific histological subtypes. Therefore, women diagnosed during first trimester are considered for an early termination of pregnancy followed The diagnosis of malignancy during pregnancy is an extremely distressing event for the patient, her family and caregivers. The need to treat the patient for a potentially lethal disease, while minimizing potential risks to the developing fetus, raises significant therapeutic and ethical dilemmas. Lymphoma presents the fourth most common malignancy in pregnancy, with an estimated prevalence of one in 6000 pregnancies [1–3], whereas leukemia, which is a relatively rare disease, is estimated to occur in one in 75,000–100,000 pregnancies [1,3]. Due to the increasing age of pregnancy in the western world and improved diagnostic techniques, the incidence of malignancy during pregnancy is expected to rise. This editorial reviews unique medical challenges associated with the most common hematological cancers reported during pregnancy, addressing therapeutic dilemmas and current recommended approaches. Notably, the rarity of hematological cancers during pregnancy precludes conduction of prospective trials; hence, the information presented here is mainly based on small retrospective studies and case reports.