Leukemia during Pregnancy: 32 Cases from a Single Institution.

In an attempt to evaluate the outcome of leukemia during pregnancy we performed a study of all such cases identified in our institution leukemia database. Thirty two cases were identified as cases of leukemia during pregnancy among the cohort of patients treated between January 1991 and July 2003. The cases were AML (15), ALL (6) and CML (11).

At diagnosis the median age was 24.5 years and the median gestational age was 16 weeks. Twenty patients were treated for their leukemia during pregnancy at a median gestational age of 20 weeks (4 in the first trimester, 8 in the second trimester and 8 patients in the third trimester).

Among the acute leukemia patients (n=21), 10 patients (47.6 %) received chemotherapy during pregnancy, 9 (90%) of them achieved CR and one patient needed salvage chemotherapy. Of these 10 patients, 7 had normal live births, one spontaneously aborted at 15 weeks of gestation and 2 had therapeutic abortion at 16 and 19 weeks of gestation. The remaining 11 (52.4%) were not given chemotherapy while pregnant as 3 patients (27.3%) presented late in their pregnancy after 34 weeks of gestation ending in normal live births and then received induction chemotherapy and 8 patients (72.7%) presented early in their pregnancy and they either spontaneously aborted or had a therapeutic termination of their pregnancy before starting chemotherapy. Among the CML patients (n=11), 9 patients received Hydroxyurea (HU) treatment during pregnancy, one patient received α-Interferon and one patient was treated with leukapheresis. Eight of the 11 patients (63.6%) had normal live births. Three patients (18.1%) aborted, 2 at 11 weeks of gestation while on HU treatment and one shortly after diagnosis before treatment. Of the total 32 patients 13 (40.6%) subsequently underwent allogeneic stem cell transplant, 8 for AML, 2 for ALL and 3 for CML. At a median follow up of 19.1 months, the disease free survival (DFS) and overall survival (OS) were 19% and 33.3% respectively for the acute leukemia patients. For CML patients, the OS was 90.9% at a median follow up of 38 months.

The above data suggest that a high CR rate and satisfactory OS can be achieved in leukemia during pregnancy. Furthermore, chemotherapy did not lead to any teratogenic effects among live births. All spontaneous and therapeutic abortions were for disease related complications and not chemotherapy induced.

This series of cases, which is the largest from a single institution, clearly supports early treatment of leukemia during pregnancy based on the underlying disease rather than concomitant pregnancy.