Acceptable Maternal, Neonatal Outcomes With Systemic Lymphoma Therapy After First Trimester

Receipt of systemic therapy can be deferred until the second or third trimester among women diagnosed with Hodgkin’s or non-Hodgkin’s lymphoma during pregnancy

medwireNews: Systemic treatment for pregnant women diagnosed with Hodgkin’s lymphoma or non-Hodgkin’s lymphoma can be initiated after the first trimester with acceptable maternal and foetal outcomes, find the authors of a brief report published in JAMA Oncology.

Of 39 women included in this study, three chose to terminate the pregnancy to allow the immediate initiation of systemic therapy, 24 received antenatal therapy (with the majority receiving doxorubicin-based combination chemotherapy) and 12 deferred treatment until after delivery.

Four of the women given antenatal treatment experienced miscarriage, of whom two were treated in the first trimester and two in the second trimester. The study authors believe that factors other than treatment contributed to the foetal death in at least one of the latter cases, as one of the patients was critically ill.

But add that their findings justify the withholding of multi-agent chemotherapy during the first trimester because of the vulnerability of the foetus during organogenesis.

No patient in the postnatal treatment group had a miscarriage, but the difference between the postnatal and antenatal therapy groups was not significant.

The groups also did not differ significantly with respect to preterm delivery rates, at 29% and 42% among women who received treatment during pregnancy and those who deferred it, respectively.

Receipt of antenatal versus postnatal therapy did not affect gestational length at delivery, with women in both groups giving birth at a median of 37 weeks. And no gross malformations or anomalies were detected among the infants of 31 women for whom neonatal outcomes were available.

Maternal outcomes were also “acceptable”, say Michelle Fanale, from the University of Texas MD Anderson Cancer Center in Houston, USA, and colleagues, with 5-year progression-free survival (PFS) and overall survival (OS) rates of 74.7% and 82.4%, respectively, after a median follow-up of 67.9 months.

Of note, PFS and OS rates were similar regardless of whether a patient received therapy during the antenatal period or not.

And the only factors significantly associated with poor outcomes on multivariate analysis were poor performance status and presence of extranodal nonbone marrow disease, which are known adverse risk factors among nonpregnant lymphoma patients, observe the researchers.

“In this series, the decision to defer therapy until after delivery did not affect maternal outcomes”, they write.

“Our findings, coupled with those from previous studies, lead us to recommend delaying therapy to the second trimester if this can be accomplished without perceived detriment to the patient.”

Reference

Pinnix CC, Osborne EM, Chihara D, et al. Maternal and fetal outcomes after therapy for Hodgkin or non-Hodgkin lymphoma diagnosed during pregnancy. JAMA Oncol 2016; Advance online publication 26 May. doi: 10.1001/jamaoncol.2016.1396

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