Professional paper
LEUKEMIA AND PREGNANCY. NO LONGER A DANGEROUS LIAISON? – CASE REPORT AND REVIEW OF LITERATURE
Ana-Maria Vladareanu
; Hematology Department, Emergency University Hospital, Bucharest
Viola Popov
; Hematology Department, General County Hospital, Pitesti
Veronica Vasilache
; Hematology Department, Emergency University Hospital, Bucharest
Cristina Marinescu
; Hematology Department, Emergency University Hospital, Bucharest
Horia Bumbea
; Hematology Department, Emergency University Hospital, Bucharest
MOna Zvanca
; Obstetrics and Gynecology Department, Elias Emergency University Hospital, Bucharest
Diana Cisleanu
; Hematology Department, Emergency University Hospital, Bucharest
Madalina Begu
; Hematology Department, Emergency University Hospital, Bucharest
Minodora Onisai
; Hematology Department, Emergency University Hospital, Bucharest
Sinziana Radesi
; Hematology Department, Emergency University Hospital, Bucharest
Christian Andrei
; Obstetrics and Gynecology Department, Elias Emergency University Hospital, Bucharest
Radu Vladareanu
; Obstetrics and Gynecology Department, Elias Emergency University Hospital, Bucharest
Abstract
Purpose. Even though there are no solid data regarding chemotherapy treated leukemia during pregnancy, the results based on short series reports show that the management of such condition can be safely achieved during the second and third trimester. We present three personal cases of pregnant women treated with cytostatic agents, two of them accidentally receiving complete chemotherapy during the entire pregnancy without malformative consequences. First case. A 19 yrs old woman diagnosed with chronic myeloid leukemia who conceived spontaneously and mistook the pregnancy signs for a relapse of the disease. During the pregnancy she continued the treatment, receiving until the fifth month an association of Hydroxyurea and alfa-interferon and afterwards switched to Imatinib until term. She presented at 38–39 weeks and delivered by cesarean section a little girl of 3510 g in a perfect state of health. The blood count of both mother and child were normal. Second case. A similar situation in a young woman with lymphoblastic acute leukemia under treatment with Vincristin, Methotrexat, Purinethol. She presented in advanced spontaneous labour at 33–34 weeks and delivered a little girl of 1700 g without malformative signs and normal blood count. Third case. A 17 years old girl who was diagnosed with acute myeloid leukemia at 29 weeks pregnancy. She received induction chemotherapy with Ara-C, due to the significant bone marrow infiltrate and disease induced disseminated intravascular coagulopathy. She presented premature uterine contractions at 32 weeks and delivered by cesarean section a premature boy of 1750g with Apgar score 8. The infant did not present any malformation (by clinical and ultrasound examination) and the blood count was normal.
The studies have shown so far that in the case of chronic myeloid leukemia, the treatment with Imatinib was associated with 50% apparently normal live infants and that chemotherapy for acute leukemia during the second or third trimester may not require termination of pregnancy, because both remission and delivery of a normal infant are likely to be obtained.
Keywords
leukemia; pregnancy; chemotherapy; imatinib
Hrčak ID:
62101
URI
Publication date:
1.6.2008.
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