In a nutshell
This study was carried out to assess the outcomes of pregnant women who have non-Hodgkin lymphoma (NHL). The authors concluded that treating NHL with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-like regimens during pregnancy can be considered after the first trimester.
NHL is usually treated with systemic therapy (drug therapy that spreads throughout the body to kill cancer cells). CHOP is a form of systemic therapy used in the treatment of NHL. Rituximab (R; Rituxan) is an immune therapy commonly used to treat NHL.
Systemic therapy can be damaging to the developing fetus during pregnancy. Until now the treatment of NHL in pregnancy with CHOP or R-CHOP has been unclear.
Methods & findings
A total of 80 patients with NHL diagnoses during pregnancy were identified. Most patients (67.5%) were diagnosed with NHL during the second trimester of pregnancy. The most common NHL subtype was diffuse large B-cell lymphoma (DLBCL; 71%), followed by follicular lymphoma (FL; 8%) The average follow-up was 51.5 months for all patients.
Overall, 54 (68%) patients with NHL were treated with chemotherapy after the second trimester of pregnancy. CHOP with or without rituximab (R-CHOP) was the most common treatment regimen. 11 patients did not start treatment until after pregnancy or termination of the pregnancy.
75 pregnancies resulted in a live birth. 4 pregnancies were terminated early and 1 resulted in a stillbirth before starting treatment. 37% of patients had spontaneous deliveries. 2 children exposed to R-CHOP during the first trimester were born with a heart condition or a kidney abnormality. 44.4% of children of patients with DLBCL were small for their birth-age.
In women with DLBCL, the survival rate without disease progression (PFS) at 3-years was 77.5% and the overall survival (OS) at 3-years was 90%. R-CHOP resulted in a PFS of 83.4% and an OS of 95.7% at 3-years. Including rituximab in the treatment regimen during pregnancy resulted in an increased PFS of 91.7% and an OS of 100% in 17 patients with limited-stage NHL. Including rituximab after delivery of the baby resulted in a poorer outcome with a PFS of 62.5% and an OS of 87.5% in patients with DLBCL.
The bottom line
The authors concluded that standard CHOP-like treatment for NHL can be offered to pregnant patients after the first trimester. The authors suggest that patients should be followed up in specialized obstetric units, as there are risks of complications such as preterm birth or small for birth age babies.
The fine print
This study was based on medical records. Information might have been missing.
Published By :
British Journal of Haematology
Sep 18, 2020
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