A Multicenter Retrospective Experience of Hematologic Neoplasms in Pregnancy

INTRODUCTION: Cancer is diagnosed in 0.07% to 0.1% of pregnancies and represent the second cause of maternal death after vascular complications. Hematologic malignancies account for 25% of all malignancies in pregnancy. It is always a challenge to confront a case of a pregnant woman with any type of cancer, requires a great multidisciplinary team and so far there is no a world-wide expert group in the treatment of this type of patients. The world's experience on approach and treatment of women with cancer is limited to cases series and recommendations with low scientific evidence. Latin America and particularly Mexico has a different clinical behavior to that reported in the developed countries and does not have a consensus of treatment for these patients.

OBJETIVES: To report our multicenter experience in the setting of hematologic malignancies during the pregnancy.

MATERIALS AND METHODS: This is a retrospective multicenter study that collects the information available in the databases of 9 hospitals in Mexico from January 1993 to June 2017 with diagnosis of pregnancy and hematologic cancer. Epidemiological data in relation to type of cancer, treatment as well as features of pregnancy, childbirth and newborn were colected.

RESULTS: A total of 101 patients from 9 Mexican medical institutions were diagnosed with the following hematologic malignancies: 88 cases of leukemia (16% acute myeloid leukemia (AML), 34% acute lymphoblastic leukemia (ALL), 2 cases of T ALL, 3% Mixed lymphocytic leukemia, 35% chronic myeloid leukemia (CML), 7 cases of Hodgkin's lymphoma, 5 cases of non-Hodgkin's lymphoma, 1 case of myelofibrosis. The mean age at diagnosis was 23 years old (14-41), 46% were diagnosed before week 20 of gestation, 49% during week 21 to 35 and 6% after week 36. 35 patients received no treatment (34.6%). Of the women who received treatment, the drugs used according to the type of neoplasia were imatinib (28.7%), interferon alpha (10.6%), hydroxyurea (7.5%), cytarabine + doxorubicin (18.1%), vincristine + doxorubicin + prednisone + L-asparaginase (24.2%), Hyper CVAD (4.5%), ABVD (4.5%), R-CHOP (1.98%). 51 cases (50.4%) were diagnosed with hematological malignancies and under treatment, prior to pregnancy. Within the Acute Leukemia group (51%) there were 20 deaths; In those diagnosed with lymphoma no deaths were recorded and there was 1 death due to blast crisis in CML. In the group that received chemotherapeutic treatment (65.3%) there were 12 fetal deaths, treatment-related structural alterations in only 3 newborns, 45% healthy and the rest had mild reversible complications.

CONCLUSIONS: We report the largest series of cases in malignant hemopathies in pregnancy. The results show the need to organize multidisciplinary work teams to improve the care and treatment of this type of patients.