A new analysis provides the first data to help the care of pregnant women with relapsed lymphoma, researchers have reported.
According to the analysis of 23 patients, women with relapsed/refractory lymphoma during pregnancy experienced a “overwhelmingly positive overall survival rates” of 83%, but a progression-free survival rate of 24%.
A lymphoma diagnosis during pregnancy occurs in about one in 4,000 women. On rare occasions, women who achieved remission from a previous lymphoma diagnosis find out their cancer has returned during pregnancy. However, there is little evidence to guide clinicians on how to treat it.
A team led by Dr Andrew Evens from Rutgers Cancer Institute of New Jersey analysed the outcomes of pregnant women with relapsed/refractory (r/r) lymphoma based on the timing of the pregnancy and type of lymphoma.
In this retrospective analysis, published in Blood Advances, the team identified 23 patients with r/r lymphoma, who were diagnosed at a median of 20 weeks’ gestation.
About 80% of patients included in the study had classic Hodgkin’s lymphoma. Most elected to delay chemotherapy until after giving birth, while five chose to begin treatment during pregnancy, due to personal preference and the potentially life-threatening nature of their cancer diagnoses.
The team writes that the cohort of patients had an overwhelmingly positive overall survival rate of 83% at three years, but progression-free survival at three years was 24%.
Out of the group of 23 pregnant patients, 19 women delivered live births – most of whom were induced and more than half preterm. Four patients terminated their pregnancies or experienced spontaneous abortions.
A full follow up of 15 patients found that 10 had relapsed and two had died.
Starting chemotherapy treatment during pregnancy can cause risk of harm to the foetus, but delaying treatment may result in progression of the cancer, as well as harm to the patient and child.
“These decisions are incredibly individualised and consider patient age, comorbidities, tumour volume, and the status of the lymphoma,” said Dr Evens.
“Often the patient chooses to carry the pregnancy to term and treat the cancer afterward. Conversely, there are cases where a patient is highly symptomatic, as well as cases that are life-threatening both to the patient and the foetus. Under those circumstances, we strongly consider treating the cancer during pregnancy if beyond the first trimester.”
Although it remains unknown why progression-free survival for patients in this study is so low, Dr Evens said it could be because most patients postponed cancer treatment until after their pregnancy and may not have begun treatment until after these markers were collected.
He also explained that, when possible, foetal outcomes are best when the pregnancy is carried to term.
“While every case is unique, for patients wishing to proceed with pregnancy, we generally recommend taking the gestation to term delivery at 37 weeks or beyond,” said Dr Evens. “There are previously published data from cancer patients showing that preterm delivery can significantly adversely affect the child’s cognitive scores later in life.”
He said the goal of the study was to provide data that can inform patients and providers, adding: “While an r/r lymphoma diagnosis during pregnancy is rare, we hope to ensure that oncologists and women have some form of guidance on how to approach this complex clinical scenario.”
Farooq F, Brandt JS, Cardonick E, Polushkina E, Vose JM, Ahmed S, Ramakrishnan Geethakumari P, Olszewski AJ, Yasin H, Farooq U, Hamad N, Lin Y, Maggen C, Fruscio R, Gziri MM, Steffensen KD, Amant F, Evens AM. (2023) “An International Real-World Analysis of Relapsed/Refractory Lymphoma Occurring During Pregnancy.” Blood Advances, doi: 10.1182/bloodadvances.2023010090.
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