Blood cancers

30-year data on rare non-Hodgkin lymphoma during pregnancy ‘reassuring’

Data spanning three decades has provided reassuring data on the treatment of patients diagnosed with non-Hodgkin lymphoma during pregnancy.

Analysis of data from the patients registered with the International Network on Cancer, Infertility and Pregnancy found chemotherapy can be offered after the first trimester with “reassuring” outcomes.

But the researchers found that pre-term delivery and neonatal complications from premature birth were common and recommended women are cared for in an obstetric unit that caters for high-risk patients.

Between 1986 and 2019, 80 pregnant women diagnosed with non-Hodgkin lymphoma were included in the dataset, 57 (71%) of them with diffuse large B-cell lymphoma (DLBCL), the researchers reported in the British Journal of Haematology.

Of all 80 patients, 54 (68%) pregnant patients received chemotherapy from the first trimester onwards mostly with CHOP-like regimens and the proportion of women starting treatment during pregnancy increased over the years.

Four pregnancies in the early stages were terminated, the researchers said and among the 76 that continued there was one stillbirth, thought to be due to placental abruption and before cancer treatment had begun.

In all there was a high incidence of small for gestational age neonates (39%), preterm delivery (52%), obstetric (41%) and neonatal complications (12.5%), which could not fully be explained by initiation of chemotherapy during pregnancy, the authors reported.

An in-depth analysis of data from those with DLBCL showed that three-year progression-free and overall survival for patients treated with rituximab-CHOP was 83.4% and 95.7% for those with limited stage disease and and 60.6% and 73.3% for patients with advanced stage disease.

“In conclusion, standard treatment for DLBCL can be offered to pregnant patients in obstetric centres that cater for high-risk patients,” the researchers said.

They did note that “remarkably” no negative events were registered for seven patients with DLBCL who opted to delay treatment until after delivery.

But they said follow-up data was limited and based on data from non-pregnant patients, DLBCL treatment should ideally not be delayed for more than a month.

Dr Graham Collins, lymphoma lead for Oxford University Hospitals, said the paper was useful because lymphoma in pregnancy was so rare.

“The data presented here are important to enable informed discussion with patients.

“Encouragingly, the paper generally shows good outcomes for both mother and child when the mother was treated during the 2nd or third trimester.”

But he added: “Follow up of the child in any study however will be limited so we must remain cautious and honest about limitations of our knowledge in this area.”

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