Abstract
Pregnancy-associated leukemia occurs in approximately 1 in 75,000–100,000 pregnancies. This low incidence precludes the conduct of large, prospective, controlled trials. Data are largely based on retrospective series and case reports, making evidence-based decisions difficult. Treatment of the pregnant woman with leukemia may be associated with adverse fetal outcomes. Administration of chemotherapy during the first trimester is associated with an increased risk for congenital malformations. Therefore, acute leukemia diagnosed during the first trimester mandates a strong recommendation for pregnancy termination, followed by initiation of induction therapy. When leukemia is diagnosed later in pregnancy, standard management approaches similar to those in nonpregnant patients can be used, and pregnancy termination is usually not required. Patients diagnosed with chronic myeloid leukemia (CML) during pregnancy can usually be managed with interferon alpha to decrease tumor load. Many patients with established CML and a sustained complete molecular response prior to conception may be followed without treatment throughout the pregnancy. In the rare case of chronic lymphocytic leukemia (CLL) during pregnancy, treatment can usually be delayed until after delivery.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abruzzese E, Trawinska MM, Perrotti AP, et al. Tyrosine kinase inhibitors and pregnancy. Mediterr J Hematol Infect Dis. 2014. doi:10.4084/MJHID.2014.028.
Ali S, Jones GL, Culligan DJ, et al. Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy. Br J Haematol. 2015;170:487–95.
Ault P, Kantarjian H, O'Brien S, et al. Pregnancy among patients with chronic myeloid leukemia treated with imatinib. J Clin Oncol. 2006;24:1204–8.
Avilés A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2:173–7.
Avilés A, Neri N, Nambo MJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol. 2006;17:286–8.
Avilés A, Neri N, Nambo MJ. Hematological malignancies and pregnancy: treat or no treat during first trimester. Int J Cancer. 2012;131:2678–83.
Bayraktar S, Morency B, Escalón MP. Successful pregnancy in a patient with chronic myeloid leukaemia exposed to dasatinib during the first trimester. BMJ Case Rep. 2010. doi:10.1136/bcr.05.2010.2975.
Bawle EV, Conard JV, Weiss L. Adult and two children with fetal methotrexate syndrome. Teratology. 1998;57:51–5.
Brenner B, Avivi I, Lishner M. Haematological cancers in pregnancy. Lancet. 2012;379:580–7.
Berveiller P, Andreoli A, Mir O, et al. A dramatic fetal outcome following transplacental transfer of dasatinib. Anticancer Drugs. 2012;23:754–7.
Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283–91.
Dine G, Levert M, Rehn Y. Two successful successive pregnancies in a woman with CML treated with dasatinib and temporary peg-interferon. J US China Med Sci. 2013;10:128–33.
Goh HG, Kim YJ, Kim DW, et al. Previous best responses can be re-achieved by resumption after imatinib discontinuation in patients with chronic myeloid leukemia: implication for intermittent imatinib therapy. Leuk Lymphoma. 2009;50:944–51.
Greenlund LJ, Letendre L, Tefferi A. Acute leukemia during pregnancy: a single institutional experience with 17 cases. Leuk Lymphoma. 2001;41:571–7.
Gziri MM, Hui W, Amant F, et al. Myocardial function in children after fetal chemotherapy exposure. A tissue Doppler and myocardial deformation imaging study. Eur J Pediatr. 2013;172:163–70.
Hamad N, Kliman D, Best OG, et al. Chronic lymphocytic leukaemia, monoclonal B-lymphocytosis and pregnancy: five cases, a literature review and discussion of management. Br J Haematol. 2015;168:350–60.
Hiratsuka M, Minakami H, Koshizuka S, et al. Administration of interferon-alpha during pregnancy: effects on fetus. J Perinat Med. 2000;28:372–6.
Howdeshell K, Shelby M, Walker V, et al. NTP monograph: developmental effects and pregnancy outcomes associated with cancer chemotherapy use during pregnancy. NTP Monograph. Washington, DC: National Institutes of Health, U.S. Department of Health and Human Services; 2013;2:i-214.
Hyoun SC, Običan SG, Scialli AR. Teratogen update: methotrexate. Birth Defects Res A Clin Mol Teratol. 2012;94:187–207.
Lambertini M, Peccatori FA, Azim Jr HA. Targeted agents for cancer treatment during pregnancy. Cancer Treat Rev. 2015;41:301–9.
Palani R, Milojkovic D, Apperley JF. Managing pregnancy in chronic myeloid leukaemia. Ann Hematol. 2015;94:S167–76.
Pye SM, Cortes J, Ault P, et al. The effects of imatinib on pregnancy outcome. Blood. 2008;111:5505–8.
Russell MA, Carpenter MW, Akhtar MS, et al. Imatinib mesylate and metabolite concentrations in maternal blood, umbilical cord blood, placenta and breast milk. J Perinatol. 2007;27:241–3.
Shapira T, Pereg D, Lishner M. How I treat acute and chronic leukemia in pregnancy. Blood Rev. 2008;22:247–59.
Thauvin-Robinet C, Maingueneau C, Robert E, et al. Exposure to hydroxyurea during pregnancy: a case series. Leukemia. 2001;15:1309–11.
Ticku J, Oberoi S, Friend S, et al. Acute lymphoblastic leukemia in pregnancy: a case report with literature review. Ther Adv Hematol. 2013;4:313–9.
Vantroyen B, Vanstraelen D. Management of essential thrombocythemia during pregnancy with aspirin, interferon alpha-2a and no treatment. A comparative analysis of the literature. Acta Haematol. 2002;107:158–69.
Weisz B, Meirow D, Schiff E, et al. Impact and treatment of cancer during pregnancy. Expert Rev Anticancer Ther. 2004;4:889–902.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Krashin, E., Lishner, M. (2016). Managing Leukemia During Pregnancy. In: Azim Jr, H. (eds) Managing Cancer during Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-28800-0_15
Download citation
DOI: https://doi.org/10.1007/978-3-319-28800-0_15
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-28798-0
Online ISBN: 978-3-319-28800-0
eBook Packages: MedicineMedicine (R0)