Systemic Therapy for Lymphoma Appears Safe After First Trimester

A retrospective study looking at a small number of women diagnosed with and treated for Hodgkin or non-Hodgkin lymphoma while pregnant has found that systemic therapy given after the first trimester was safe and resulted in acceptable maternal and fetal outcomes.

“The diagnosis of lymphoma during pregnancy poses management challenges requiring consideration of the fetus without compromising potentially curative therapy for the mother,” wrote Chelsea Pinnix, MD, PhD, of the University of Texas MD Anderson Cancer Center, and colleagues in JAMA Oncology. “In this series, the decision to defer therapy until after delivery did not affect maternal outcomes.”

According to the study, cancer is diagnosed in about 1 of 1,000 pregnancies. With this analysis, Pinnix and colleagues wanted to examine the maternal and fetal outcomes associated with undergoing systemic treatment for Hodgkin or non-Hodgkin lymphoma during pregnancy. They looked at 39 pregnant women diagnosed at a single center from 1991 to 2014. The median age of women was 28 and the majority (82%) had stage I or II disease.

Of the 39 women, three electively terminated the pregnancy to undergo immediate treatment for the disease. Twenty-four women received antenatal therapy; twenty with doxorubicin based combination chemotherapy. Twelve women chose to defer their treatment until after delivery.

Four of the 24 women undergoing antenatal therapy experienced miscarriage, two of which occurred in the first trimester.

“Multi-agent chemotherapy has been given rarely during the first trimester because of the vulnerability of the fetus during organogenesis,” the researchers wrote “This concern is justified because both patients who received first-trimester therapy in this study experienced fetal death.”

Delivery occurred at a median of 37 weeks. No difference in the time of delivery was found between women who underwent systemic therapy and those who deferred treatment.

With a median follow-up of 67.9 months there was a 5-year progression-free survival of 74.7% and overall survival of 82.4%. No differences in terms of survival were seen for women who underwent antenatal compared with postnatal treatment.

A multivariate analysis showed that extranodal non-bone marrow disease and performance status were both significantly associated with progression-free and overall survival among the patients who underwent therapy. However, the researchers noted that these adverse risk factors are also associated with inferior outcomes among non-pregnant patients with lymphoma.

Finally, no gross fetal malformations or anomalies were seen.

“Preterm delivery, and not fetal chemotherapy exposure, has been shown to be the most strongly predictive of neurocognitive impairment,” the researchers wrote. “Thus, an important goal should be prolonging the pregnancy so as to avoid preterm birth.”