Antiblastic treatment of hematological malignancies during pregnancy poses a number of issues related to the curability of the maternal disease, the need of a prompt treatment and the potential toxicity of chemotherapy for the fetus. Here we report the results of a systematic literature search about the management of the most frequent hematological malignancies that may occur during pregnancy, focusing on specific issues related to gestational age at diagnosis, fetal toxicity and efficacy on the maternal side. The standard approach in non-pregnant women is illustrated as reference.
HurleyTJMcKinnellJVIraniMS. Hematologic malignancies in pregnancy. Obstet Gynecol Clin North Am2005; 32: 595–614.
2.
ChenMMCoakleyFVKaimalALarosRKJr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol2008; 112(2 Pt 1): 333–340.
3.
CardonickEIacobucciA. Use of chemotherapy during human pregnancy. Lancet Oncol2004; 5: 283–291.
4.
AvilésAZepedaGCruzJ. Hodgkin's disease during pregnancy. Study of late effects in the newborn infants. Bol Med Hosp Infant Mex1991; 48: 622–626.
5.
SanzMAGrimwadeDTallmanMSLowenbergBFenauxPEsteyEHNaoeTLengfelderEBüchnerTDöhnerHBurnettAKLo-CocoF. Management of acute promyelocytic leukemia: Recommendations from an expert panel on behalf of the European LeukemiaNet. Blood2009; 113: 1875–1891.
6.
AvilesANeriN. Hematological malignancies and pregnancy: A final report of 84 children who received chemotherapy in utero. Clin Lymphoma2001; 2: 173–177.
7.
AvilesANeriNNamboMJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol2006; 17: 286–288.
8.
BallasSKMcCarthyWFGuoNDeCastroLBellevueRBartonBAWaclawiwMA; Multicenter Study of Hydroxyurea in Sickle Cell Anemia. Exposure to hydroxyurea and pregnancy outcomes in patients with sickle cell anemia. J Natl Med Assoc2009; 101: 1046–1051.
9.
NiedermeierDMFrei-LahrDAHallPD. Treatment of acute myeloid leukaemia during the second and third trimesters of pregnancy. Pharmacotherapy2005; 25: 11311140.
10.
MatsuoKShimoyaKUedaSWadaKKoyamaMMurataY. Idarubicin administered during pregnancy: Its effects on the fetus. Gynecol Obstet Invest2004; 58: 186–188.
11.
SiuBLAlomzoMRVargoTAFenrichAL. Transient dilated cardiomyopathy in a newborn exposed to idarubicin and alltrans-retinoic acid (ATRA) early in the second trimester of pregnancy. Int J Gynecol Cancer2002; 12: 399–402.
12.
PeregDLishnerM. Maternal and fetal effects of systemic therapy in the pregnant woman with cancer. Recent Results Cancer Res2008; 178:21–38.
13.
FeyMFSurbekD. Leukaemia and pregnancy. Recent Results Cancer Res2008; 178: 97–110.
14.
AultPKantarjianHO'BrienSFaderlSBeranMRiosMBKollerCGilesFKeatingMTalpazMCortesJ. Pregnancy among patients with chronic myeloid leukemia treated with imatinib. J Clin Oncol2006; 24: 1204–1208.
15.
ChakravartyEFMurrayERKelmanAFarmerP. Pregnancy outcomes after maternal exposure to rituximab. Blood2011; 117: 1499–1506.
16.
MirOBerveillerPGoffinetFTreluyerJMSerreauRGoldwasserFRouzierR. Taxanes for breast cancer during pregnancy: A systematic review. Ann Oncol2010; 21: 425–426.
17.
KellyHGrahamMHumesEDorflingerLJBoggessKAO'NeilBHHarrisJSpectorNLDeesEC. Delivery of a healthy baby after first-trimester maternal exposure to lapatinib. Clin Breast Cancer2006; 7: 339–341.
18.
AzimHAJrPeccatoriFALiptrottSJCataniaCGoldhirschA. Breast cancer and pregnancy: How safe is trastuzumab?Nat Rev Clin Oncol2009;6: 367–370.
19.
Kyoung-ChulChunKimDYKimJHKimYMKimYTNamJH. Neoadjuvant chemotherapy with paclitaxel plus platinum followed by radical surgery in early cervical cancer during pregnancy: Three case reports. Jpn J Clin Oncol2010; 40: 694–698.
20.
TaylorJAmanzeADi FedericoEVerschraegenC. Irinotecan use during pregnancy. Obstet Gynecol2009; 114(2 Pt 2): 451–452.
21.
ZhaoXYHuangHFLianLJLangJH. Ovarian cancer in pregnancy: A clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer2006; 16: 8–15.
22.
MirOBerveillerPRopertSGoffinetFGoldwasserF. Use of platinum derivatives during pregnancy. Cancer2008; 113:3069–3074.
23.
EbrahimiNMaltepeCEinarsonA. Optimal management of nausea and vomiting of pregnancy. Int J Womens Health2010; 2: 241–248.
24.
KrafftABencaiovaGBreymannC. Selective use of recombinant human erythropoietin in pregnant patients with severe anemia or nonresponsive to iron sucrose alone. Fetal Diagn Ther2009; 25: 239–245.
25.
DaleDC. Optimizing the management of chemotherapy-induced neutropenia. Clin Adv Hematol Oncol2003; 1: 679–684.
26.
LynchCMSinnottJT4thHoltDAHeroldAH. Use of antibiotics during pregnancy. Am Fam Physician1991; 43: 1365–1368.
27.
MoudgalVVSobelJD. Antifungal drugs in pregnancy: A review. Expert Opin Drug Saf2003; 2: 475–483.
28.
KorenGLishnerMSantiagoS, Editors. The Motherisk guide to cancer in pregnancy and lactation. 2nd Ed.Tornoto, Canada: Motherisk program; 2005.
29.
WeiszBSchiffELishnerM. Cancer in pregnancy: Maternal and fetal implications. Hum Reprod Update2001; 7:384–393.
30.
QuinnJRabinNRodriguez-JustoMChoiDYongK. Multiple myeloma presenting with spinal cord compression during pregnancy. Ann Hematol2009; 88: 181–182.
31.
LishnerMZemlickisDSutcliffeSBKorenG. Non-Hodgkin's lymphoma and pregnancy. Leuk Lymphoma1994; 14:411–413.
32.
TaylorGBlomJ. Acute leukemia during pregnancy. South Med J1980; 73: 1314–1315.
33.
BrennerBAviviILishnerM. Haematological cancers in pregnancy. Lancet2012; 379: 580–587.
34.
AndersonVRPerryCM. Fludarabine: A review of its use in non-Hodgkin's lymphoma. Drugs2007; 67: 1633–1655.
35.
Amitay-LayishIDavidMKafriBBarzilaiAFeinmesserMHodakE. Early-stage mycosis fungoides, parapsoriasis en plaque, and pregnancy. Int J Dermatol2007; 46: 160–165.
BheleSGujralS. Bilateral peripheral T-cell lymphoma of breast: A case report. Indian J Pathol Microbiol2007; 50: 816–818.
38.
SavvariPMatsoukaCBarbaroussiDChristoulasDNikitasNDimopoulosMAPapadimitriouCA. Burkitt's lymphoma in pregnancy with bilateral breast involvement: Case report with review of the literature. Onkologie2010; 33: 461–464.
39.
AnticNColovićMCemerikićVJankovićSPetrovićMJankoviG. Disseminated Burkitt's-like lymphoma during pregnancy. Med Oncol2000; 17: 233–236.
40.
WangPHChaoKCLinGChaoHTYuanCCNgHT. Primary malignant lymphoma of the cervix in pregnancy. A case report. J Reprod Med1999; 44: 630–632.
41.
MagloireLKPettkerCMBuhimschiCSFunaiEF. Burkitt's lymphoma of the ovary in pregnancy. Obstet Gynecol2006; 108 (3 Pt 2): 743–745.
42.
ZafarMMehmoodAAbassiMHShahSS. Primary non-Hodgkin's lymphoma of vagina associated with pregnancy. J Coll Physicians Surg Pak2006; 16: 424–425.
43.
MahendranSM. Primary non-Hodgkin's lymphoma of the vagina masquerading as a uterine fibroid in pregnancy. J Obstet Gynaecol2008; 28: 456–458.
44.
WestinJRFayadLE. Beyond R-CHOP and the IPI in large-cell lymphoma: Molecular markers as an opportunity for stratification. Curr Hematol Malig Rep2009; 4: 218–224.
45.
LamMS. Treatment of Burkitt's lymphoma during pregnancy. Ann Pharmacother2006; 40: 2048–2052.
46.
RizackTMegaALegareRCastilloJ. Management of hematological malignancies during pregnancy. Am J Hematol2009; 84: 830–841.
47.
AzimHASantoroLBociekRGGandiniSMalekRAAzimHAJr. High dose intensity doxorubicin in aggressive non-Hodgkin's lymphoma: A literature-based metaanalysis. Ann Oncol2010; 21: 1064–1071.
48.
LishnerM. Cancer in pregnancy. Ann Oncol2003; 14Suppl 3: iii31–6.
49.
EbertULöftierHKirchW. Cytotoxic therapy and pregnancy. Pharmacol Ther1997; 74: 207–220.
50.
PeccatoriFAAzimHAJrPruneriGPipernoGRavielePRPredaLCioccaMOrecchiaRMartinelliG. Management of anaplastic large-cell lymphoma during pregnancy. J Clin Oncol2009; 27: e75–77.
51.
CordeiroAMachadoAIBorgesAAlvesMJFradeMJ. Burkitt's lymphoma related to Epstein-Barr virus infection during pregnancy. Arch Gynecol Obstet2009; 280: 297–300.
52.
PetersonCLesterDRJr.SangerW. Burkitt's lymphoma in early pregnancy. J Clin Oncol2010; 28: e136–138.
53.
BachanovaVConnorsJM. How is Hodgkin lymphoma in pregnancy best treated? ASH evidence-based review 2008. Hematology Am Soc Hematol Educ Program2008; 33–34.
54.
WooSYFullerLMCundiffJHBondyMLHagemeisterFBMcLaughlinPVelasquezWSSwanFJrRodriguezMACabanillasFAllenPKCarpenterRJ. Radiotherapy during pregnancy for clinical stages IA-IIA Hodgkin's disease. Int J Radiat Oncol Biol Phys1992; 23: 407–412.
55.
SpinaMCarboneAGloghiniASerrainoDBerrettaMTirelliU. Hodgkin's Disease in Patients with HIV Infection. Adv Hematol2011; 2011: pii: 402682.
GobbiPGAttardo-ParrinelloADanesinoMMottaCDi PriscoAURizzoSCAscariE. Hodgkin's disease and pregnancy. Haematologica1984; 69: 336–341.
58.
LishnerMZemlickisDDegendorferPPanzarellaTSutcliffeSBKorenG. Maternal and foetal outcome following Hodgkin's disease in pregnancy. Br J Cancer1992; 65: 114–117.
59.
AnselmoAPCavalieriEEnriciRMPescarmonaEGuerrisiVPaesanoRPachìAMandelliF. Hodgkin's disease during pregnancy: Diagnostic and therapeutic management. Fetal Diagn Ther1999; 14: 102–105.
60.
SaganDSemczukALampkaE. Combination chemotherapy for Hodgkin's lymphoma during pregnancy: Favorable outcome for mother and child. J Obstet Gynaecol Res2010; 36: 882–886.
61.
IriyamaNHorikoshiATanakaTHirabayashiYKodairaHHattaYTakeuchiJ. Successful treatment of Hodgkin lymphoma in second trimester of pregnancy: Feasibility of ABVD regimen. Int J Hematol2011; 94: 104–107.
62.
OkechukwuCNRossJ. Hodgkin's lymphoma in a pregnant patient with acquired immunodeficiency syndrome. Clin Oncol (R Coll Radiol)1998; 10: 410–411.
63.
KlepfishASchattnerAShtalridMShvidelLBerrebiABentwichZ. Advanced Hodgkin's disease in a pregnant HIV seropositive woman: Favorable mother and baby outcome following combined anticancer and antiretroviral therapy. Am J Hematol2000; 63: 57–58.
64.
British Committee for Standards in Haematology, MilliganDWGrimwadeDCullisJOBondLSwirskyDCraddockCKellJHomewoodJCampbellKMcGinleySWheatleyKJacksonG. Guidelines on the management of acute myeloid leukaemia in adults. Br J Haematol2006; 135: 450–474. GermannNGoffinetFGoldwasserF. Anthracyclines during pregnancy: Embryo-fetal outcome in 160 patients. Ann Oncol2004; 15: 146–150.
65.
FinazziG. How to manage essential thrombocythemia. Leukemia2012; 26: 875–882.
66.
HarrisonC. Pregnancy and its management in the Philadelphia negative myeloproliferative diseases. Br J Haematol2005; 129: 293–306.
67.
ShapiraTPeregDLishnerM. How I treat acute and chronic leukemia in pregnancy. Blood Rev2008; 22: 247–259.
68.
GermannNGoffinetFGoldwasserF. Anthracyclines during pregnancy: Embryo-fetal outcome in 160 patients. Ann Oncol2004; 15: 146–150.
69.
YangDHladnikL. Treatment of acute promyelocytic leukemia during pregnancy. Pharmacotherapy2009; 29: 709–724.
70.
StockW. Adolescents and young adults with acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program2010; 2010: 21–29.
71.
MatsoukaCMarinopoulosSBarbaroussiDAntsaklisA. Acute lymphoblastic leukemia during gestation. Med Oncol2008; 25: 190–193.
72.
HansenWFFretzPHunterSKYankowitzJ. Leukemia in pregnancy and fetal response to multiagent chemotherapy. Obstet Gynecol2001; 97 (5 Pt 2): 809–812.
73.
ChelghoumYVeyNRaffouxEHuguetFPigneuxAWitzBPautasCde BottonSGuyotatDLioureBFegueuxNGarbanFSaadHThomasX. Acute leukemia during pregnancy: A report on 37 patients and a review of the literature. Cancer2005; 104: 110–117.
74.
EfficaceFCocksKBrecciaMSprangersMMeyersCAVignettiMBaccaraniMMandelliF; GIMEMA and EORTC Quality of Life Group. Time for a new era in the evaluation of targeted therapies for patients with chronic myeloid leukemia: Inclusion of quality of life and other patient-reported outcomes. Crit Rev Oncol Hematol2012; 81: 123–135.
75.
PyeSMCortesJAultPHatfieldAKantarjianHPilotRRostiGApperleyJF. The effects of imatinib on pregnancy outcome. Blood2008; 111: 5505–5508.
76.
AliROzkalemkasFKimyaYKoksalNOzkocamanVGultenTYorulmazHTunaliA. Imatinib use during pregnancy and breast feeding: A case report and review of the literature. Arch Gynecol Obstet2009; 280: 169–175.
77.
KuwabaraABabbAIbrahimAMilojkovicDApperleyJBuaMReidAForoniLRezvaniKGoldmanJMarinD. Poor outcome after reintroduction of imatinib in patients with chronic myeloid leukemia who interrupt therapy on account of pregnancy without having achieved an optimal response. Blood2010; 116: 1014–1016.
78.
KrollTAmesMBPruettJAFenskeTS. Successful management of pregnancy occurring in a patient with chronic myeloid leukemia on dasatinib. Leuk Lymphoma2010; 51: 1751–1753.
79.
ConchonMSanabaniSSSerpaMNovaesMMNardinelliLFerreiraPBDorliac-LlacerPEBenditI. Successful Pregnancy and Delivery in a Patient with Chronic Myeloid Leukemia while on Dasatinib Therapy. Adv Hematol. 2010; 2010: 136252.
80.
BerveillerPAndreoliAMirOAnselemODelezoideALSauvageonHChapuisNTsatsarisV. A dramatic fetal outcome following transplacental transfer of dasatinib. Anticancer Drugs2012 Mar 14. [Epub ahead of print].
81.
HiratsukaMMinakamiHKoshizukaSSatoI. Administration of interferon-alpha during pregnancy: Effects on fetus. J Perinat Med2000; 28: 372–376.
82.
AliROzkalemkaşFOzkocamanVOzçelikTOzanUKimyaYTunaliA. Successful pregnancy and delivery in a patient with chronic myelogenous leukemia (CML), and management of CML with leukapheresis during pregnancy: A case report and review of the literature. Jpn J Clin Oncol2004; 34: 215–217.
83.
GürmanG. Pregnancy and successful labor in the course of chronic lymphocytic leukemia. Am J Hematol2002; 71: 208–210.
84.
AliROzkalemkasFKimyaYKoksalNOzkocamanVYorulmazHErogluAOzcelikTTunaliA. Pregnancy in chronic lymphocytic leukemia: Experience with fetal exposure to chlorambucil. Leuk Res2009; 33: 567–569.
85.
SteegeJFCaldwellDS. Renal agenesis after first trimester exposure to chlorambucil. South Med J1980; 73: 1414–1415.
86.
BaerMROzerHFoonKA. Interferon-alpha therapy during pregnancy in chronic myelogenous leukaemia and hairy cell leukaemia. Br J Haematol1992; 81: 167–169.
87.
BustamanteARodríguezMAOcqueteauMBertínPLiraPValbuenaJ. Hairy cell leukemia during pregnancy: Report of one case. Rev Med Chil2010; 138: 1422–1426.
88.
AvilésANeriN. Multiple myeloma and pregnancy. Am J Hematol2011; 86: 81–82.
89.
de MozotaD BorjaKadhelPDermecheSMultignerLJankyE. Multiple myeloma and pregnancy: A case report and literature review. Arch Gynecol Obstet2011; 284: 945–950.
90.
QuinnJRabinNRodriguez-JustoMChoiDYongK. Multiple myeloma presenting with spinal cord compression during pregnancy. Ann Hematol2009; 88: 181–182.
91.
MaglioneADi GiorgioGPetruzzelliFLongoMP. Multiple myeloma diagnosed during early pregnancy: A case report. Eur J Obstet Gynecol Reprod Biol2003; 111: 214–215.
92.
KasendaBRückertAFarthmannJSchillingGSchnerchDPrömpelerHWäschREngelhardtM. Management of multiple myeloma in pregnancy: Strategies for a rare challenge. Clin Lymphoma Myeloma Leuk2011; 11: 190–197.
93.
ZunKHChoiHM. Multiple myeloma presenting as vertebral compression during pregnancy. Int J Gynaecol Obstet2008; 100:89–90.
94.
KosovaLASchwartzSO. Multiple myeloma and normal pregnancy. Report of a case. Blood1966; 28: 102–111.
95.
PalumboARajkumarSV. Treatment of newly diagnosed myeloma. Leukemia2009; 23: 449–456.
96.
DjokanovicNKlieger-GrossmannCKorenG. Does treatment with bisphosphonates endanger the human pregnancy?J Obstet Gynaecol Can2008;30: 1146–1148.
97.
ToogehGFerdowsiSNaadaliFAlimoghaddamKGhavamzadehAShirkoohiRGhaffariSH. Concomitant presence of JAK2 V617F mutation and BCR-ABL translocation in a pregnant woman with polycythemia vera. Med Oncol2011; 28: 1555–1558.
98.
de GuibertSde LatourRPVaroqueauxNLabussièreHRioBJaulmesDEveillardJRDulucqSStoppaAMBouscaryDGirodonFBonnotteBLaskriDSociéGLamyT. Paroxysmal nocturnal hemoglobinuria and pregnancy before theeculizumab era: The French experience. Haematologica2011; 96: 1276–1283.