Relapse of acute lymphoblastic leukemia during pregnancy

A young woman had a late relapse from acute lymphoblastic leukemia during her first pregnancy at the 17th week of gestation and decided not to interrupt the pregnancy. A partial remission was obtained with mild chemotherapy (vincristine and prednisone) in a month, then the treatment was intensified, but only partial remission was achieved. A cesarean section was performed at the end of the 7th month, with the delivery of a normal male infant. The patient died of refractory leukemia 9 months later. The baby is now 3 years old with no medical problems. This case suggests that: a) pregnancy might be associated with an increased risk of relapse in women in continuous complete remission from leukemia; b) chemotherapy, even intensive, can be safely administered to pregnant women without damaging the fetus, after the first trimester.