Successful Treatment of Acute Myelocytic Leukemia in Pregnancy Complicated with Lung Abscess

Acute leukemia in pregnancy is a rare event and the cytotoxic treatment during pregnancy remains controversial due to the concerns on significant teratogenicity led by chemotherapeutic agents. We here reported a woman who was diagnosed as acute myelocytic leukemia and lung abscess underwent a standard chemotherapy of DA regimen at her early third trimester of gestation and delivered a healthy baby without any abnormalities by Caesarean section. A 24-year-old woman at her 29th weeks of pregnancy was admitted because she experienced shortness of breath for one month and fever and cough with expectoration for three days. At admission, she had a moderate fever and looked severely anemic with no lymphadenopathy and hepatosplenomegaly. The whole blood counts showed her hemoglobin was 31 g/L, WBC 8.5 × 10⁹/L with 42% blasts and platelet 13 × 10⁹/L. The morphologic, immunophenotyping and cytogenetic findings of the bone marrow samples met the criteria of acute myelocytic leukemia (AML-M2a) diagnosis. Computerized tomography of chest indicated pneumonia with the formation of right lung abscess. Ultrasound examination revealed a normal-appearing fetus and an anterior placenta. Since the patient insisted maintaining the pregnancy, a standard induction regimen of daunorubicin and cytarabine was initiated and broad-spectrum antibiotics were simultaneously prescribed to control the pulmonary infection. During profound myelosuppression, granulocyte stimulating factor and anti-fungal agents were also administrated. After 4 weeks of induction, the patient’s symptoms all disappeared and her peripheral blood counts completely recovered. A repeat bone marrow aspirate confirmed complete leukemia remission. A living baby boy weighed 2200g was delivered by Caesarean section 2 weeks later (at the 35th week of gestation). Physical examinations and laboratory tests showed a healthy baby without any abnormalities. The mother is still in good condition and receives scheduled consolidation and maintenance therapy. The growth and development of the baby is also normal at the time of writing (8 months after birth). Our experience suggested chemotherapy of acute leukemia at the third trimester may not require termination of pregnancy since a remission of leukemia and delivery of a healthy baby can be obtained.