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Hodgkin Lymphoma in Pregnancy

  • Lymphomas (J Armitage, Section Editor)
  • Published:
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Abstract

The peak incidence of Hodgkin lymphoma (HL) coincides with reproductive years, and as many as 3 % of all HL patients present with concurrent pregnancy. The management of a pregnant patient with HL requires a multidisciplinary approach combining expertise in medical oncology, high-risk obstetrics, and neonatology, as well as effective communication with the patient and her family. The goal is to optimize the mother’s chance of a cure while allowing for delivery of a healthy child. A pregnant patient with HL should be staged by clinical examination and judicious use of non-radiation imaging such as ultrasound, balancing the need for accurate disease assessment with the need to minimize invasive procedures. The treatment strategy is individualized to the symptoms, lymphoma stage, gestational age and the patients’ wishes. Therapeutic options include treatment deferral or single-agent vinblastine with reservation of multi-agent chemotherapy until the second or third trimester for the small minority of patients with aggressive clinical presentation.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189:1128–35.

    Article  PubMed  Google Scholar 

  2. Connors JM. Clinical manifestations and natural history of Hodgkin’s lymphoma. Cancer J. 2009;15:124–8.

    Article  PubMed  Google Scholar 

  3. Connors JM. Challenging problems: coincident pregnancy, HIV infection, and older age. Hematol Am Soc Hematol Educ Program. 2008;334–9.

  4. Bachanova V, Connors JM. How is Hodgkin lymphoma in pregnancy best treated? ASH evidence-based review 2008. Hematol Am Soc Hematol Educ Program. 2008;33–4.

  5. • Zanotti-Fregonara P, Jan S, Taieb D, et al. Absorbed 18F-FDG dose to the fetus during early pregnancy. J Nucl Med. 2010;51:803–5. Impact of PET/CT imaging on pregnancy.

    Article  PubMed  Google Scholar 

  6. O'Connor SJ, Verma H, Grubnic S, Rayner CF. Chest radiographs in pregnancy. BMJ. 2009;339:b4057.

    Article  PubMed  Google Scholar 

  7. Nicklas AH, Baker ME. Imaging strategies in the pregnant cancer patient. Semin Oncol. 2000;27:623–32.

    PubMed  CAS  Google Scholar 

  8. Lishner M, Zemlickis D, Degendorfer P, et al. Maternal and foetal outcome following Hodgkin’s disease in pregnancy. Br J Cancer. 1992;65:114–7.

    Article  PubMed  CAS  Google Scholar 

  9. Gobbi PG, Attardo-Parrinello A, Danesino M, Motta C, Di Prisco AU, Rizzo SC, et al. Hodgkin’s disease and pregnancy. Haematologica. 1984;69:336–41.

    PubMed  CAS  Google Scholar 

  10. Nisce LZ, Tome MA, He S, et al. Management of coexisting Hodgkin’s disease and pregnancy. Am J Clin Oncol. 1986;9:146–51.

    Article  PubMed  CAS  Google Scholar 

  11. Jacobs C, Donaldson SS, Rosenberg SA, Kaplan HS. Management of the pregnant patient with Hodgkin’s disease. Ann Intern Med. 1981;95:669–75.

    Article  PubMed  CAS  Google Scholar 

  12. Barry RM, Diamond HD, Craver LF. Influence of pregnancy on the course of Hodgkin’s disease. Am J Obstet Gynecol. 1962;84:445–54.

    PubMed  CAS  Google Scholar 

  13. Aviles A, Diaz-Maqueo JC, Talavera A, et al. Growth and development of children of mothers treated with chemotherapy during pregnancy: current status of 43 children. Am J Hematol. 1991;36:243–8.

    Article  PubMed  CAS  Google Scholar 

  14. Canada AL, Schover LR. The psychosocial impact of interrupted childbearing in long-term female cancer survivors. Psychooncology. 2012;21:134–43.

    Article  PubMed  Google Scholar 

  15. Gelb AB, van de Rijn M, Warnke RA, Kamel OW. Pregnancy-associated lymphomas. A clinicopathologic study. Cancer. 1996;78:304–10.

    Article  PubMed  CAS  Google Scholar 

  16. Thomas PR, Biochem D, Peckham MJ. The investigation and management of Hodgkin’s disease in the pregnant patient. Cancer. 1976;38:1443–51.

    Article  PubMed  CAS  Google Scholar 

  17. Byram D, Foulstone P. Radiotherapy for Hodgkin’s disease in pregnancy. Australas Radiol. 1997;41:407–8.

    PubMed  CAS  Google Scholar 

  18. Anselmo AP, Cavalieri E, Enrici RM, et al. Hodgkin’s disease during pregnancy: diagnostic and therapeutic management. Fetal Diagn Ther. 1999;14:102–5.

    Article  PubMed  CAS  Google Scholar 

  19. Mazonakis M, Lyraraki E, Varveris C, et al. Conceptus dose from involved-field radiotherapy for Hodgkin’s lymphoma on a linear accelerator equipped with MLCs. Strahlenther Onkol. 2009;185:355–63.

    Article  PubMed  Google Scholar 

  20. Friedman E, Jones GW. Fetal outcome after maternal radiation treatment of supradiaphragmatic Hodgkin’s disease. CMAJ. 1993;149:1281–3.

    PubMed  CAS  Google Scholar 

  21. Latourette HB. Induction of lymphoma and leukemia by diagnostic and therapeutic irradiation. Radiol Clin N Am. 1968;6:57–61.

    PubMed  CAS  Google Scholar 

  22. Ng AK, Bernardo MV, Weller E, et al. Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood. 2002;100:1989–96.

    Article  PubMed  CAS  Google Scholar 

  23. Ebert U, Loffler H, Kirch W. Cytotoxic therapy and pregnancy. Pharmacol Ther. 1997;74:207–20.

    PubMed  CAS  Google Scholar 

  24. Tawil E, Mercier JP, Dandavino A. Hodgkin’s disease complicating pregnancy. J Can Assoc Radiol. 1985;36:133–7.

    PubMed  CAS  Google Scholar 

  25. Rosenzweig AI, Crews Jr QE, Hopwood HG. Vinblastine sulfate in Hodgkin’s disease in pregnancy. Ann Intern Med. 1964;61:108–12.

    Article  PubMed  CAS  Google Scholar 

  26. Lacher MJ, Geller W. Cyclophosphamide and vinblastine sulfate in Hodgkin’s disease during pregnancy. JAMA. 1966;195:486–8.

    Article  PubMed  CAS  Google Scholar 

  27. Dilek I, Topcu N, Demir C, et al. Hematological malignancy and pregnancy: a single-institution experience of 21 cases. Clin Lab Haematol. 2006;28:170–6.

    Article  PubMed  CAS  Google Scholar 

  28. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol. 2004;5:283–91.

    Article  PubMed  CAS  Google Scholar 

  29. Fanale MA, Lai C-M, Rimes SA, et al. Positive maternal-fetal outcomes with treatment of lymphoma during pregnancy: UT MD Anderson Cancer Prospective Experience. Presented at Annual American Society of Hematology meeting. Salt Lake City, USA, December 8–12, 2012

  30. • Anatolian Group AMOS, Ustaalioglu BB, Gumus M, et al. Malignancies diagnosed during pregnancy and treated with chemotherapy or other modalities (review of 27 cases): multicenter experiences. Int J Gynecol Cancer. 2011;20:698–703. Multicenter case series of recent date.

    Article  Google Scholar 

  31. •• Van Calsteren K, Heyns L, De Smet F, et al. Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 2010;28:683–9. The paper presents neonatal and obstetrics outcomes of patients with invasive cancer diagnosed during pregnancy collected of over 20 years in international collaborative setting.

    Article  PubMed  Google Scholar 

  32. Klepfish A, Schattner A, Shtalrid M, et al. Advanced Hodgkin’s disease in a pregnant HIV seropositive woman: favorable mother and baby outcome following combined anticancer and antiretroviral therapy. Am J Hematol. 2000;63:57–8.

    Article  PubMed  CAS  Google Scholar 

  33. Okechukwu CN, Ross J. Hodgkin’s lymphoma in a pregnant patient with acquired immunodeficiency syndrome. Clin Oncol (R Coll Radiol). 1998;10:410–1.

    Article  CAS  Google Scholar 

  34. Armstrong JG, Dyke RW, Fouts PJ. Vinblastine sulfate treatment of Hodgkin’s disease during a pregnancy. Science. 1964;143:703.

    Article  PubMed  CAS  Google Scholar 

  35. Dildy 3rd GA, Moise Jr KJ, Carpenter Jr RJ, Klima T. Maternal malignancy metastatic to the products of conception: a review. Obstet Gynecol Surv. 1989;44:535–40.

    Article  PubMed  Google Scholar 

  36. • Amant F, Van Calsteren K, Halaska MJ, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol. 2012;13:256–64. This paper present the multicenter observational cohort study recording the general health, cardiac function, and neurodevelopmental outcomes of children who were prenatally exposed to chemotherapy.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Minnesota, Minneapolis, MN, 55455, USA

    Veronika Bachanova

  2. BC Cancer Agency Centre for Lymphoid Cancer, 600 West 10th Avenue, Vancouver, BC, Canada, V5Z 4E6

    Joseph M. Connors

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  1. Veronika Bachanova
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  2. Joseph M. Connors
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Correspondence to Joseph M. Connors.

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Bachanova, V., Connors, J.M. Hodgkin Lymphoma in Pregnancy. Curr Hematol Malig Rep 8, 211–217 (2013). https://doi.org/10.1007/s11899-013-0163-4

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  • DOI: https://doi.org/10.1007/s11899-013-0163-4

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