Treatment Options for Hodgkin's Disease During Pregnancy

Treatment results of 47 pregnant women with Hodgkin's disease (HD) are analyzed using data reported in the literature since 1960. Twenty-three of the patients were treated with radiation during pregnancy and 17 of the 23 patients (74%) were reported to be long term disease-free survivors. All of these pregnancies resulted in normal deliveries and the babies were evaluated to have no abnormalities at birth. Termination of pregnancy was performed in 12 patients and 10 (83%) of them survived with no evidence of disease after subsequent treatment. In 12 patients, the treatment was initiated only after delivery and 9 (75%) of the 12 patients are disease-free survivors. The characteristics of the patients as well as an analysis of the results according to treatment approach practiced in each trimester of pregnancy are reported. The radiation dose to the fetus is evaluated and the factors affecting the dose are analyzed Experience with administering chemotherapy for HD during pregnancy is also reviewed. Twenty-six patients were treated during the first trimester. The patients treated with procarbazine, chlorambucil, cyclophosphamide or combination chemotherapy in the first trimester had abortions or malformed babies. When vinblastine was used during the first trimester in 13 patients, and nitrogen mustard in 3 patients, each of the 16 patients were reported to have delivered normal babies. When chemotherapy was used during the second or third trimesters, no abnormalities of the newborns were reported This review suggests that the cure rate of HD is unlikely to be compromised in pregnancy in spite of the fact that radiation or chemotherapy had to be modified in order to conserve the fetus. The treatment alternatives in each trimester are discussed and the consequences of administering radiation or chemotherapy during pregnancy are reviewed.