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Published on: September 12, 2019
Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter
Andrew M Evens1, Ranjana Advani, Oliver W Press
1Andrew M. Evens, Tufts University School of Medicine, Boston; Aimee Kroll-Desrosiers, University of Massachusetts Medical School, Worcester, MA; Ranjana Advani and Stavroula Otis, Stanford University Medical Center, Stanford, CA; Oliver W. Press and Linda M. Parker, Fred Hutchinson Cancer Research Center, Seattle, WA; Izidore S. Lossos, Liat Nadav Dagan, and Jose Sandoval, University of Miami School of Medicine, Miami, FL; Julie M. Vose, University of Nebraska Medical Center, Omaha, NE; Francisco J. Hernandez-Ilizaliturri, Roswell Park Cancer Institute, Buffalo; Ramsey Abdallah and John P. Leonard, Weill Cornell Medical College, New York, NY; Barrett K. Robinson, Indiana University School of Medicine, Indianapolis, IN; Jessica L. Yarber and Leo I. Gordon, Northwestern University Feinberg School of Medicine, Chicago, IL; Kristie A. Blum, The Ohio State University, Columbus, OH; Christopher R. Flowers, Emory University, Atlanta, GA; Thomas M. Habermann, Mayo Clinic, Rochester, MN; and Nancy L. Bartlett, Washington University School of Medicine, St. Louis, MO.
Purpose:
Lymphoma is the fourth most frequent cancer in pregnancy; however, current clinical practice is based largely on small series and case reports.
Patients And Methods:
In a multicenter retrospective analysis, we examined treatment, complications, and outcomes for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) occurring during pregnancy.
Results:
Among 90 patients (NHL, n = 50; HL, n = 40), median age was 30 years (range, 18 to 44 years) and median diagnosis occurred at 24 weeks gestation. Of patients with NHL, 52% had advanced-stage versus 25% of patients with HL (P = .01). Pregnancy was terminated in six patients. Among the other 84 patients, 28 (33%) had therapy deferred to postpartum; these patients were diagnosed at a median 30 weeks gestation. This compared with 56 patients (67%) who received antenatal therapy with median lymphoma diagnosis at 21 weeks (P < .001); 89% of these patients received combination chemotherapy. The most common preterm complication was induction of labor (33%). Gestation went to full term in 56% of patients with delivery occurring at a median of 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus antenatal therapy. At 41 months, 3-year progression-free survival (PFS) and overall survival (OS) for NHL were 53% and 82%, respectively, and 85% and 97%, respectively, for HL. On univariate analysis for NHL, radiotherapy predicted inferior PFS, and increased lactate dehydrogenase and poor Eastern Cooperative Oncology Group performance status (ECOG PS) portended worse OS. For HL patients, nulliparous status and "B" symptoms predicted inferior PFS.
Conclusion:
Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.
