Hairy cell leukaemia (HCL) represents less 1% of all lymphoid neoplasms with cases rarely reported in pregnancy. Management of HCL requires multidisciplinary care to optimise maternal and neonatal outcomes.
Methods
A literature search of Ovid MEDLINE and EMBASE for ‘hairy cell leukaemia’ and ‘Pregnancy’ was undertaken.
Results
Thirteen cases were reviewed including three within our own institutions. Interferon-alpha was the most prominent treatment at varying doses in n = 3 (23%) patients. Other management included antenatal cladribine and rituximab, post-partum cladribine with and without rituximab, laparoscopic splenectomy and termination of pregnancy. 46.1% (n = 6) of patients birthed vaginally. Due to thrombocytopenia, there was a greater proportion of caesarean delivery under general anaesthetic and half of the cases documented bleeding complications.
Conclusion
Diagnosis and management of HCL in pregnancy is difficult. Women can be managed safely and outcome aims should be the same as non-pregnant patients.
WiberMMaitreEPoncetJM, et al.A population-based study of hairy cell leukemia over a period of 20 years. Cancer Treat Res Commun2020; 25: 100236.
2.
SakriAAMNuseeZAhmad MustafaAM,et al.A review of hematological malignancy in pregnancy. Eur J Med Health Sci2021; 3: 67–71.
3.
AinoonO, et al.Hairy cell leukemia: a case report. Med J Malays1988; 43: 62–64.
4.
ShackletonL, et al.Hairy cell leukemia masquerading as pancytopenia in pregnancy. Case Rep Hematol2019; 2019: 3238168.
5.
BaerMROzerHFoonKA. Interferon-Alpha therapy during pregnancy in chronic myelogenous leukaemia and hairy cell leukaemia. Br J Haematol1992; 81: 167–169.
6.
DaverNNazhaAKantarjianHM, et al.Treatment of hairy cell leukemia during pregnancy: are purine analogues and rituximab viable therapeutic options. Clin Lymphoma Myeloma Leuk2013; 13: 86–89.
7.
AdenijiBAFallasMIncerpiM, et al.Lparoscopic splenectomy for hairy cell leukemia in pregnancy. Case Rep Med2010; 2010: 1–2.
8.
AlothmanASparlingTG. Managing hairy cell leukemia in pregnancy. Ann Intern Med1994; 120: 1048–1049.
9.
PatsnerBPenneyRWWalshCM. Recurrent hairy cell leukemia during pregnancy: a case report. Am J Obstet Gynecol1994; 170: 1380–1381.
10.
WilliamsJK. Hairy cell leukemia in pregnancy: a case report. Am J Obstet Gynecol1987; 156: 210–211.
11.
PinsonPBoussaidIDecroocqJ, et al.Maternal and obstetric outcomes in women with pregnancy-associated haematological malignancies: an observational nationwide cohort study. Lancet Haematol2024; 11: e850–e861.
12.
The obstetric hematology manual. In: PavordSHuntB (eds) The obstetric hematology manual. Cambridge: Cambridge University Press, 2018, pp.i–ii.
13.
Abbassi-GhanavatiMGreerLGCunninghamFG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol2009; 114: 1326–1331.
14.
ReeseJAPeckJDDeschampsDR, et al.Platelet counts during pregnancy. N Engl J Med2018; 379: 32–43.
15.
ZhuJZexinLYuguoD,et al.Comprehensive reference intervals for white blood cell counts during pregnancy. BMC Pregnancy Childbirth2024; 24: 35.
16.
MahmoudHKSamraMAFathyGM. Hematologic malignancies during pregnancy: a review. J Adv Res2016; 7: 589–596.
17.
TroussardXMaîtreECornetE. Hairy cell leukemia 2022: update on diagnosis, risk-stratification, and treatment. Am J Hematol2022; 97: 226–236.
18.
GreverMRAbdel-WahabOAndritsosLA, et al.Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood2017; 129: 553–560.
19.
MaitreECornetETroussardX. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol2019; 94: 1413–1422.
20.
FelkerAPatelRKotnisR, et al.(eds), on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care Compiled report – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2020–22. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2024.
21.
Datta - Datta P, Ciplea AI, Rewers-Felkins K, et al. Cladribine transfer into human milk: a case report. Mult Scler J 2021; 27: 799–801.
22.
Krysko KM, LaHue SC, Anderson A, et al. Minimal breast milk transfer of rituximab, a monoclonal antibody used in neurological conditions. Neurol Neuroimmunol Neuroinflammation 2020; 7: 1–6.
23.
Lau - LauRJ, Emery MG and Galinsky RE. Unexpected accumulation of Acyclovir in breast milk with estimation of infant exposure. Obstet Gynecol 1987; 69: 468–471.
24.
TaddioA, Klein J and Koren G. Acyclovir Excretion in human breast milk. Ann Pharmacother 1994; 28: 585–587.
25.
HaleTW. Medications and Mother's Milk. 19th ed. Texas: Hale Publishing L.P., 2021.
26.
MillsGSChadwickVTangC, et al.Immunochemotherapy for life-threatening haematological malignancies in pregnancy: a systematic review of the literature and cross-sectional analysis of clinical trial eligibility. Lancet Haematol2023; 10: e458–e467.
27.
PerrottaK, et al.Pregnancy outcomes following maternal treatment with rituximab prior to or during pregnancy: a case series. Rheumatol Adv Pract2021; 5: rkaa074.
28.
BanLTataLJFiaschiL,et al.Limited risks of major congenital anomalies in children of mothers with Ibd and effects of medications. Gastroenterology2014; 146: 76–84.
29.
MalekaAEnbladGSjorsG, et al.Treatment of metastatic malignant melanoma with vemurafenib during pregnancy. J Clin Oncol2013; 31: e192–e193.
30.
MarceDCornillierHDenisC, et al.Partial response of metastatic melanoma to BRAF-inhibitor-monotherapy in a pregnant patient with no fetal toxicity. Melanoma Res2019; 29: 446–447.
31.
de HaanJvan ThienenJVCasaerM, et al.Severe adverse reaction to vemurafenib in a pregnant woman with metastatic melanoma. Case Rep Oncol2018; 11: 119–124.
32.
Vemurafenib. The women’s pregnancy and breastfeeding medicine guide, 2024. November 22 2024.
33.
SmirnovaSYAl-RadiLSMoiseevaTN, et al.Inhibitor of BRAFV600E mutation as a treatment option for hairy cell leukemia with deep neutropenia and infectious complications. Clin Lymphoma Myeloma Leuk2021; 21: 427–430.
34.
GreverMAndritsosLBanerjiV, et al.Hairy cell leukemia and COVID-19 adaptation of treatment guidelines. Leukemia2021; 35: 1864–1872.
35.
AliAAEldinIB. Outcome of pregnancy in women with splenomegaly. BMC Pregnancy Childbirth2023; 23: 144.
36.
Module 5 Obstetrics and Maternity: Patient Blood Management Guidelines. 2015.
37.
Di CiaccioPRMillsGTangC,et al.Managing haematological malignancies in pregnant women. Lancet Haematol2021; 8: e623–e624.
