Original Articles
Vol. 10 (2018): Review Articles, Original Articles, Scientific Letters, Case Reports
https://doi.org/10.4084/mjhid.2018.006

TREATMENT OF EARLY STAGES HODGKIN LYMPHOMA DURING PREGNANCY

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Received: October 8, 2017
Accepted: November 29, 2017
Published: January 1, 2018
4236
Views
1000
Downloads
861
HTML
Hematological malignancies and pregnancy, Hodgkin lymphoma and pregnancy, Chemotherapy during pregnancy
Hematology

Authors

Agustin Avilès
aamiranda12@gmail.com
Mexican Institute of Social Security, Mexico.
Maria-Jesus Nambo
Mexican Institute of Social Security, Mexico.
Natividad Neri
Mexican Institute of Social Security,, Mexico.

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

 

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Rizak T, Mega A, Legare R, Castillo J.: Management of hematological malignancies during pregnancy. Am J Hematol 2009;84:830-841. https://doi.org/10.1002/ajh.21547 PMid:19844988
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
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
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
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-#
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.
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
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
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.
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
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
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
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
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
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
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.
BoiceJB Jr, Miller RW.: Childhood and adult cancer after intrauterine exposure to ionizing radiation. Teratology 1999;59:227.233.
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.
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

Ethics Approval

Original article
Agustin Avilès, Mexican Institute of Social Security
Oncology Research Unit, Oncology Hospital, National Medical Center, IMSS, México D.F.MEXICO
Maria-Jesus Nambo, Mexican Institute of Social Security
Department of Hematology, oncology Hospital, National Medical Center, IMSS, Mèxico DF, MEXICO
Natividad Neri, Mexican Institute of Social Security,
Department of Hematology, Oncology Hospital, National Medical Center, IMSS, México D.F MEXICO

How to Cite



“TREATMENT OF EARLY STAGES HODGKIN LYMPHOMA DURING PREGNANCY” (2018) Mediterranean Journal of Hematology and Infectious Diseases, 10(1), p. e2018006. doi:10.4084/mjhid.2018.006.