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Lancet Haematol. 2019 Nov;6(11):e551-e561. doi: 10.1016/S2352-3026(19)30195-4. Epub 2019 Sep 26.

Obstetric and maternal outcomes in patients diagnosed with Hodgkin lymphoma during pregnancy: a multicentre, retrospective, cohort study.

Author information

1
Department of Obstetrics and Gynaecology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium.
2
Department of Haematology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium.
3
Department of Haematology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
4
Leuven Biostatistics and Statistical Bioinformatics Centre, KU Leuven-University of Leuven, Leuven, Belgium.
5
Department of Obstetrics and Gynaecology, Cooper, University Health Care, Camden, NJ, USA.
6
National Medical Research Centre for Obstetrics, Gynaecology and Perinatology named after Academician V.I. Kulakov of the Ministry of Healthcare of Russian Federation, Moscow, Russia.
7
Department of Haematology, University Medical Centre Groningen, University of Groningen, Netherlands.
8
Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) "Reference clinic for haemato-oncological diseases during pregnancy CREHER" Estado de México, México.
9
Department of Obstetrics, Cliniques Universitaires St Luc, UCL, Sint-Lambrechts-Woluwe, Belgium.
10
Faculty Hospital Kralovske Vinohrady and 3rd Medical Faculty, Charles University, Prague, Czech Republic.
11
Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
12
Department of Obstetrics, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium.
13
Cooper Medical School, Rowan University, Camden, NJ, USA.
14
Department of Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
15
Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; Sackler Faculty of Medicine, TA University, Tel Aviv, Israel.
16
Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Leuven, Belgium.
17
Department of Obstetrics and Gynaecology, University Hospitals Leuven and Department of Oncology, KU Leuven, Leuven, Belgium; Centre for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centres, Amsterdam, Netherlands; Centre for Gynaecological Oncology Amsterdam, Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, Netherlands. Electronic address: f.amant@nki.nl.

Abstract

BACKGROUND:

Outcomes for mother and child following a diagnosis of Hodgkin lymphoma during pregnancy are underinvestigated, and antenatal management of the disease has not been reported on widely. The aim of this study was to assess obstetric outcomes, antenatal management, and maternal survival in patients with Hodgkin lymphoma diagnosed during pregnancy who were registered in the International Network on Cancer, Infertility and Pregnancy (INCIP) database.

METHODS:

We did a multicentre, retrospective cohort study including oncological and obstetric data from 134 pregnant patients diagnosed with Hodgkin lymphoma between Jan 1, 1969, and Aug 1, 2018. Data collected from the INCIP database were obtained from 17 academic centres in Belgium, Czech Republic, Denmark, Greece, Israel, Italy, Mexico, the Netherlands, Russia, the UK, and the USA. We analysed patients' management over three epochs (before 1995, 1995-2004, and 2005-18). Obstetric outcomes (birthweight, obstetric or neonatal complications, and admission to a neonatal intensive care unit [NICU]) of patients who received antenatal chemotherapy were compared to those of patients who did not receive antenatal treatment. Maternal progression-free and overall survival was assessed by disease stage at diagnosis in pregnant patients and compared with outcomes of non-pregnant patients with Hodgkin lymphoma selected from databases of three tertiary centres, matched for stage and prognostic score. All patients included in survival analyses received standard doxorubicin, bleomycin, vinblastine and dacarbazone (ABVD) therapy since Jan 1, 1997.

FINDINGS:

Of the 134 pregnant patients diagnosed with Hodgkin lymphoma during pregnancy. 72 (54%) patients initiated antenatal chemotherapy, 56 (42%) did not receive treatment during pregnancy, and 6 (4%) received only radiotherapy. Over the years, chemotherapy was increasingly commenced during pregnancy. The incidence of neonates who were small for gestational age did not differ between chemotherapy-exposed neonates (15 [22%] of 69) and non-exposed neonates (six [16%] of 42; p=0·455). Admission to NICU also did not differ between groups (19 [29%] exposed to antenatal chemotherapy vs 12 [35%] unexposed to antenatal chemotherapy). Birthweight percentiles were lower in neonates prenatally exposed to chemotherapy compared with non-exposed neonates (p=0·035). Patients receiving antenatal therapy had more obstetric complications than those without antenatal therapy (p=0·005), the most common complications being preterm contractions (nine [12%] vs three [7%]) and preterm rupture of membranes (four [5%] vs 0). For the maternal survival analyses, we compared 77 pregnant patients and 211 non-pregnant, matched controls. 5-year progression-free survival for patients with early-stage Hodgkin lymphoma was 82·6% (95% CI 67·4-91·1) for 62 pregnant patients and 88·3% (81·6-92·7) for 142 controls (hazard ratio [HR] 1·80, 95% CI 0·84-3·87; p=0·130; 5-year overall survival was 97·3% (82·3-99·6) and 98·4% (93·6-99·6; HR 1·63, 0·35-7·65; p=0·534). In patients with advanced-stage disease (15 pregnant patients and 69 non-pregnant controls), 5-year progression-free survival was 90·9% (95% CI 50·8-98·7) versus 74·0% (60·9-83·3); HR 0·36, 95% CI 0·04-2·90; p=0·334. 5-year overall survival was 100% (no events occurred) and 96·2% (95% CI 85·5-99·1; HR cannot be estimated; p=0·146).

INTERPRETATION:

Occurrence of preterm contractions or preterm rupture of membranes was higher in patients with Hodgkin lymphoma receiving antenatal treatment compared with those who did not initiate treatment during pregnancy. Maternal survival did not differ between pregnant and non-pregnant patients with Hodgkin lymphoma, suggesting that antenatal chemotherapy or deferral of treatment until postpartum in selected patients can be considered, with regular obstetric follow-up to safeguard foetal growth.

FUNDING:

European Research Council, Research foundation Flanders, and Charles University Ministry of Health of the Czech Republic.

PMID:
31564649
DOI:
10.1016/S2352-3026(19)30195-4
[Indexed for MEDLINE]

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