Pregnant patients can receive standard treatment with chemotherapy for non-Hodgkin lymphoma (NHL) when treated at a medical center that caters to high-risk pregnancies, according to research published in the British Journal of Haematology.
Researchers identified a cohort of 80 patients from the International Network on Cancer, Infertility and Pregnancy (INCIP) diagnosed with NHL during pregnancy. They focused their research further on 57 patients who had diffuse large B-cell lymphoma (DLBCL), the most common subtype of NHL, to determine maternal and neonatal outcomes.
Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with rituximab (R-CHOP) is the standard therapy for patients with DLBCL. Some patients may be able to delay treatment until after pregnancy. However, the authors noted that many patients diagnosed with DLBCL during pregnancy are at an advanced stage and need immediate treatment.
Of the cohort, 67.5% of patients were diagnosed in the second trimester; 75 pregnancies resulted in live births; 68% of patients opted to receive chemotherapy during pregnancy, and 2 children (2.8%) exposed to R-CHOP after the first trimester had congenital malformations.
Of the 57 patients with DLBCL, 41% had advanced-stage disease; 46 patients were treated with CHOP or R-CHOP, and 11 deferred treatment until after pregnancy termination or delivery. Preterm delivery was reported among 52% of patients with DLBCL. Receiving chemotherapy did not appear to be associated with an increased risk for preterm delivery when compared to those who did not receive chemotherapy. Preterm delivery was often planned to accommodate cancer treatment.
Rates of obstetric (41%) and neonatal (12.5%) complications, as well as neonates small for gestational age (39%) were high in the cohort. The rate of birth defects (2.8%) is consistent with the general population and the authors were not able to conclude that all instances were caused by chemotherapy. The rate of small for gestational age neonates was comparable in children exposed to chemotherapy and those not exposed, but exposed children had lower birth weight percentiles.
The authors noted that rituximab is estimated to improve survival in patients with DLBCL by 15% to 20%, arguing that the benefits of its use outweigh the risks. In the cohort studied, the rate of 3-year progression-free survival for patients with DLBCL who received R-CHOP was 83.4% for limited-stage disease and 60.6% for advanced stage disease. Overall survival was 95.7% for limited-stage disease and 73.3% for advanced-stage disease.
NHL during pregnancy is rare, and the study conclusions are limited by the study’s retrospective nature and small patient size. Overall, the authors concluded that women who are pregnant and have DLBCL can receive standard treatment during pregnancy.
Maggen C, Dierickx D, Cardonick E, et al. Maternal and neonatal outcomes in 80 patients diagnosed with non-Hodgkin lymphoma during pregnancy: results from the International Network of Cancer, Infertility and Pregnancy. Br J Haematol. Published online September 18, 2020. doi:10.1111/bjh.17103