Lymphomas can affect people of all ages, certain subtypes are often diagnosed among young women, and 1 out of every 1000 of these diagnoses coincide with pregnancy.1-3 Despite this, literature on best practices for the treatment of lymphoma among pregnant women is scarce. To address the gap in knowledge, 2 experts in the fields of lymphoma and obstetric medicine authored a case report and review of current practices for the treatment of lymphoma in the unique setting of pregnancy, which was published in Blood.4
“The bottom line when you’ve got a woman with any medical condition in pregnancy, whether it be lymphoma or not, is to ask yourself the question: If this woman wasn’t pregnant, what treatment would I offer her,” Claire McLintock, MD, coauthor of the article and lead clinician of the Obstetric Physician Team at Auckland City Hospital in New Zealand, said in an interview. “What is the treatment that gives her the best prognosis or potential for a cure?”
Lymphomas diagnosed among pregnant women are often aggressive, requiring immediate therapy. Despite this fact, “In this age group, the good thing is that the vast majority of these lymphomas in women who are pregnant are curable,” according to Kieron Dunleavy, MD, who is the coauthor of the article and director of the Lymphoma Program at George Washington University Cancer Center in Washington, DC.
A Case of Unfavorable Hodgkin Lymphoma During Early Pregnancy
A woman aged 38 years at 12+4 weeks’ gestation presented at the hospital after 2 hours of chest pain. A large anterior mediastinal mass was identified by X-ray and a biopsy led to a diagnosis of Hodgkin lymphoma with a nodular sclerosing subtype.
“There’s a perception that one cannot use any form of chemotherapy in pregnancy. In the literature, there’s no definite evidence that giving chemotherapy causes any physical damage to the infant. I’m generally comfortable, as soon as a woman is through to the second trimester, that we can start [chemotherapy] treatment,” commented Dr McLintock.
After reaching the second trimester, the physicians chose to administer adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD), as it has been shown to be less toxic then other drug combinations. The patient received her first cycle of ABVD at 15+4 weeks’ gestation and continued every 2 weeks until completing 5 cycles. At 37+1 weeks’ gestation, she had a spontaneous rupture of membranes resulting in a successful vaginal birth to a healthy baby weighing 4195 g. The patient had complete metabolic remission at the most recent follow-up.
A Case of Primary Mediastinal B Cell Lymphoma During Late Pregnancy
A woman aged 37 years at 30+6 weeks’ gestation presented at the hospital with chest pain, shortness of breath, and cramps in her right calf which had persisted for a few weeks. A computerized tomography (CT)-pulmonary angiogram showed a large mediastinal mass causing significant obstruction of the superior vena cava and left main pulmonary artery and a narrowing of the left upper lobe bronchi. A biopsy of the mass led clinicians to diagnose the patient with primary mediastinal B cell lymphoma (PMBCL).
The patient was given high dose steroids for her obstructed superior vena cava, which significantly reduced the mass’ size after 2 weeks of therapy. At 33+3 weeks’ gestation, she was given dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, etoposide, and rituximab (DA-EPOCH-R). Labor was induced at 35+5 weeks in which a healthy 2585 g baby was born. The patient received her second cycle of DA-EPOCH-R at 4 days postpartum, completing 6 total cycles. During the most recent follow-up, she remained in complete remission.