Relapsed Classical Hodgkin Lymphoma in Pregnancy in Two Patients Managed With a Multidisciplinary Approach

Relapsed or refractory (r/r) classical Hodgkin lymphoma (cHL) during pregnancy is rare, and management is often complex. The following two cases of r/r cHL during pregnancy highlight management considerations and outcomes in this unique patient population. The first patient with Stage IIIB cHL achieved a complete response (CR) with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) prior to pregnancy but relapsed at 10 weeks of gestation. She was maintained with methylprednisolone and vinblastine with no complications until she underwent cesarean section at 34 weeks. The second patient, diagnosed with Stage IIIb cHL, achieved CR after five cycles of ABVD and one cycle of AVD. She began consolidation radiation but halted treatment after two cycles upon discovering an intrauterine twin pregnancy. At 10 weeks of gestation, she experienced a relapse of her disease. The patient received one cycle of vinblastine and methylprednisolone weekly. At 31 weeks, the patient underwent an elective cesarean section. After delivery, both patients underwent ICE (ifosfamide, carboplatin, and etoposide), followed by consolidation with autologous hematopoietic cell transplantation (auto-HCT). These cases highlight the balance needed to maintain control of disease to allow a safe and uneventful pregnancy.