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Chemotherapy Can Be Given in Second and Third Trimester to Pregnant Women With Lymphoma: Presented at ACOG

By Maggie Schwarz

WASHINGTON, D.C. -- May 11, 2006 -- Lymphoma can be safely diagnosed and treated during pregnancy, and chemotherapy in the second and third trimester appears to be safe to the fetus, according to research presented here at the 54^th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG).

Elyce Cardonick, MD, associate professor, department of obstetrics and gynecology, Cooper University Hospital, Camden, New Jersey, studied a cohort of 22 pregnant women with lymphoma.

"There's no need to terminate pregnancy in women with lymphoma, as chemotherapy can be given in the second and third trimester," Dr. Cardonick stated in her presentation on May 9^th.

Dr. Cardonick and colleagues maintain a registry of women who are diagnosed with cancer during pregnancy or who get pregnant while undergoing treatment for cancer. The registry currently contains 150 women, 22 of whom had Hodgkin's or non-Hodgkin's lymphoma diagnosed during pregnancy. Fifty-eight of the women in the registry are cancer survivors who got pregnant after being treated for cancer.

Of the 22 women with lymphoma, 2 received chemotherapy post partum and 20 received it in the second and third trimester. All 22 women delivered live-born infants, a mean of 5 weeks early. Some of the women had induced labors so they could remain on chemotherapy. Mean birth weight was 2.5 kg (5.5 lbs).

A single malformation, syndactyly of 2 fingers, was repaired surgically. Complications of delivery included preterm labor in twins, and intrauterine growth retardation in a singleton.

Three women (all with Hodgkin's disease) died of recurrent disease at a mean of 3 years after delivery. One (stage IV at diagnosis) was treated with only 3 of the 4 standard agents due to pregnancy. A second (stage III) declined pelvic radiation post partum to preserve fertility and died 7 months after a subsequent pregnancy. The third woman (stage II and with twins) received lower doses of chemotherapy compared to nonpregnant women. Maternal survival of the present cohort to date is 86.6%.

Mean age of the offspring at follow-up is 32 months, the oldest being 87 months. Ninety-four percent are meeting developmental milestones, 1 is followed for delayed expressive speech and 1 is being evaluated for minor hearing loss.

Dr. Cardonick concluded, "Lymphoma can be safely diagnosed and treated during pregnancy, and chemotherapy in the second and third trimester appears safe. Pregnant women given different regimens or lower doses of chemotherapy because of the pregnancy may be at risk for recurrence, however."


[Presentation title: The Diagnosis and Treatment of Lymphoma During Pregnancy: Maternal and Fetal Outcomes. Abstract p. 33S]

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