TREATMENT OF EARLY STAGES HODGKIN LYMPHOMA DURING PREGNANCY
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Keywords
Hematological malignancies and pregnancy, Hodgkin lymphoma and pregnancy, Chemotherapy during pregnancy
Abstract
Objetive. To assess maternal and fetal outcome of women who receiving chemotherapy during pregnancy to treat Hodgkin lymphoma(HL) in early stages (IA and IIA), we performed an retrospective analysis of 44 women with HL at early stage, diagnosed and treated between 1988 to 2010, in a tertiary reference cancer center.
Methods:We analyze data of HL: clinical characteristics and treatment; and special attention to maternal and fetal complications ; children : physical development, assess scholar performance phsycological, cardiac and neurological function and intellegence tests.
Results: Forty-four pregnant women were enrolled. Median age was 29.4 (range 21-37)years; most patients were stage IIA (86%), had mediastinal bulky disease (78%) and > 3 nodal sites involved; thus these patients were recorded to have a not favourable condition. Abortion was refused when proposed. All patients received combined chemotherapy: ABVD) ( adryamicin, bleomycin, vinblastine and dacarbazine), even during first trimester, at standar doses and schedules. Radiotherapy, when necessary was administered after delivery in 39 patients. No obstetrical complications were observed. Delivery ocurred between 31 to 36 weks in 10 patients (22%) and > 37 weeks in 34 cases (77%). Four newborns were low-weight: 2012 (median) (range:1750 -2350) g. No clinical malformations were observed and development of children were normal without evidence of cardiac, neurological damage. Behavior, scholar attendance and intellegence tests were normal. With a median follow-up of 120.4 (range 48-299) months, progression-free survival and overall survival were 93% and 95 %, respectively.
Conclusion: Chemotherapy as initial therapy appear to be thes best therapeutic approach in these setting of patients, with a excelent outcome to both: mother and children. If radiotherapy is necessary, could be administered after delivery
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References
2. Lishner M, Avivi I, ApperleyJF, et al.: Hematological malignancies in pregnancy. Management guidelines from a international consensus meeting. J Clin Oncol 2016;38:501-508. https://doi.org/10.1200/JCO.2015.62.4445 PMid:26628463
3. Pinnix CC, Andraos , Migrom S, Fanale MA.: The management of lymphoma in the setting of pregnancy. CurrHematolMalig Rep 2017;12:251-256. https://doi.org/10.1007/s11899-017-0386-x
4. Lishner M, Zemlikis D, Degendorfer P, et al.: Maternal and fetal outcome following Hodgkin's disease in pregnancy. Br J Cancer 1992;68:114-117. https://doi.org/10.1038/bjc.1992.21
5. Gelb AB, Vanderigne M, WarnkeRZ, KamelRA.. Pregnancy associated lymphoma. Cancer 1996; 78:304-310. https://doi.org/10.1002/(SICI)1097-0142(19960715)78:2<304::AID-CNCR18>3.0.CO;2-#
6. Walsh EM, O'Kane GM, CalooKA, et al.: Is chemotherapy always required for cancer in pregnancy. Irish J Med Sci (in press)doi:10.1007/s11845.017-017-1602-3.
7. Pereg D, Koren G, Lishner M.: The treatment of Hodgkin and non-Hodgkin's lymphoma in pregnancy . Haematologica 2007;92:1230-1237. https://doi.org/10.3324/haematol.11097 PMid:17666365
8. Pinnix CC, Osborne EM, Chihama C, et al.: Maternal and fetal outcome after therapy for Hodgkin and non-Hodgkin lymphoma diagnosed during pregnancy. JAMA Oncol 2016;3:1065-1069. https://doi.org/10.1001/jamaoncol.2016.1396 PMid:27227654
9. Evers AM, Advani R, Press OW, et al.: Lymphoma occurring during pregnancy: Antenatal therapy, complications and maternal survival in a multicenter analysis. J Clin Oncol 2013;4132-4139.
10. Eyre TA, Lau IJ, Mackillop L, Collins GP.: Management and controversies of classical Hodgkin lymphoma in pregnancy. Br J Haematol 2015;169:513-630. https://doi.org/10.1111/bjh.13327 PMid:25684034
11. Aviles A, Neri N.: Hematological malignancies and pregnancy. A final report of 84 children who received chemotherapy in utero Clin Lymphoma 2001;2:173-175. https://doi.org/10.3816/CLM.2001.n.023 PMid:11779294
12. Aviles A, Neri N, Nambo MJ.: Hematological malignancies and pregnancy. Treat or not treat during pregnancy. Int J Cancer 2012;131:2678-2683 https://doi.org/10.1002/ijc.27560 PMid:22511239
13. Sasse S, BröckelmannPJ, Goergen H, et al.: Long-term follow-up of contemporary treatment in early-stage Hodgkin's lymphoma. J ClinOncol 2017;35:1999-2007. https://doi.org/10.1200/JCO.2016.70.9410 PMid:28418763
14. Aviles A, Delgado S.: A prospective trial comparing chemotherapy, radiotherapy and combined therapy in the treatment of early stage Hodgkin disease with bulky disease. Clin Lab Haematol 1998;20:95-99. https://doi.org/10.1046/j.1365-2257.1998.00096.x PMid:9681219
15. Amit V, Barzilat M, Avivi I.: Management of hematological malignancies. Special consideration in pregnant women. Drugs 2015:75:1725-1738. https://doi.org/10.1007/s40265-015-0464-0 PMid:26416583
16. Klieger –Grossman C, Djokanovic N, Chitaya D, Koren G.: In utero exposure to therapeutic radiation for Hodgkin lymphoma. Can Fam Phys 2009; 55:988.991.
17. BoiceJB Jr, Miller RW.: Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology 1999;59:227.233.
18. Mazorakis M, Lyraraki E, Varveris C, Samara E, Zourak K, Damiasakis J.: Concepts dose from involved-field radiotherapy for Hodgkin's lymphoma or a linear accelerator equipped with MLC. AtrahlentherOnkol 2009;85:355-363.
19. Weisbull CE, Elorantz S, Smedby K, et al.: Pregnancy and the risk of relapse in diagnosis with Hodgkin lymphoma. J Clin Oncol 2016;34:337-344. https://doi.org/10.1200/JCO.2015.63.3446 PMid:26668344