Acute leukemia during pregnancy: a single center experience with 23 cases, 2012-2022 and literature review
Wei Liu1,2,3,4, Jiamin Guo5, Dongzheng Gai6,7
1Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Background And Objective:
Acute Leukemia (AL) diagnosed during pregnancy is uncommon, and the management of AL complicated by pregnancy is a poorly studied area that faces a therapeutic dilemma.
Method:
23 cases diagnosed with AL during pregnancy were collected from our center between 2012 and 2022. Additionally, we summarized 17 clinical studies on AL diagnosed during pregnancy.
Result:
Sixteen AML and seven ALL patients were diagnosed during pregnancy in our center; most patients diagnosed during the first or second trimester tended to receive chemotherapy after abortion. All patients diagnosed during the third trimester opted to defer therapy until after delivery. The rate of overall response rate (ORR) was 77.3%, which was found to be similar to that of the general population. A Short delay in initiating anti-leukemia treatment is not associated with a negative impact on prognosis. We conducted a meta-analysis of the literature, and the summary relative complete remission (CR) rate was 76.9% (95%CI 69.1-84.6%) (Random Effects Model I^2 = 66%, p <0.001). We included four Chinese studies comprising 135 participants for further analysis. For non-M3 AL patients, CR rate of the chemotherapy-first cohort was 63.6%, compared with 68.6% in the treatment-after-delivery or abortion cohort (p = 0.657). For M3 patients, the rate was 100 and 83.3%, respectively (p < 0.001).
Conclusion:
Our findings suggest that for non-M3 AL patients can sometimes be managed during pregnancy. For M3 patients, early treatment potentially yield favorable outcomes for both the mother and fetus, using ATRA-based regimens without arsenic trioxide (in the second and third trimester) or standard chemotherapy (in the second trimester) may be considered a treatment option.
