Treatment for Hodgkin lymphoma during pregnancy appears safe
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Treating women for Hodgkin lymphoma during pregnancy appeared safe and did not significantly affect maternal outcomes, according to results of a retrospective cohort study published in The Lancet Haematology.
“The most important message is that maternal prognosis is the same as in nonpregnant women,” Frédéric Amant, MD, PhD, professor of gynecologic oncology at Netherlands Cancer Institute in Amsterdam, told HemOnc Today. “There was some doubt, [because] there is always some chemodilution and the effect on efficacy has been poorly studied. However, we can now tell mothers and fathers that lymphoma treatment during pregnancy is possible, and not at the cost of inferior maternal survival.”
Amant and colleagues performed a multicenter retrospective cohort study of 134 pregnant women aged 41 years or younger with Hodgkin lymphoma at 17 centers participating in the International Network on Cancer, Infertility and Pregnancy (INCIP) registry from 1969 to Aug. 1, 2018.
Fifty-four percent of women initiated antenatal chemotherapy, 42% did not receive treatment during pregnancy and 4% received radiotherapy only.
Researchers analyzed obstetric outcomes, antenatal management and maternal survival. They compared obstetric outcomes of women who received antenatal chemotherapy with those of women who did not receive antenatal treatment.
Researchers found that incidence of neonates who were small for gestational age did not differ significantly between chemotherapy-exposed neonates (22%) and nonexposed neonates (16%). Neonatal ICU admission also did not appear to differ between those exposed and not exposed to antenatal chemotherapy (29% vs. 35%).
However, birthweight percentiles were lower for neonates exposed prenatally to chemotherapy compared with nonexposed neonates (P = .035). Antenatal therapy appeared associated with increased obstetric complications compared with no antenatal therapy exposure (P = .005). The most common complications included preterm contractions (nine vs. three) and preterm rupture of membranes (four vs. none).
Researchers then assessed maternal PFS and OS by disease stage at diagnosis among 77 pregnant women with Hodgkin lymphoma and 211 nonpregnant women with Hodgkin lymphoma, matched according to stage and prognostic score. All women in the survival analysis received standard treatment with doxorubicin, bleomycin, vinblastine and dacarbazine.
Results showed 5-year PFS among women with early-stage disease of 82.6% (95% CI, 67.4-91.1) for 62 pregnant women and 88.3% (95% CI, 81.6-92.7) for 142 nonpregnant women (HR = 1.8; 95% CI, 0.84-3.87).
Researchers observed 5-year OS of 97.3% (95% CI, 82.3-99.6) among pregnant women vs. 98.4% (95% CI, 93.6-99.6) among nonpregnant women (HR = 1.63; 95% CI, 0.35–7.65).
Among 15 pregnant women and 69 nonpregnant women with advanced-stage disease, 5-year PFS was 90.9% (95% CI, 50.8-98.7) for the pregnant women and 74% (95% CI, 60.9-83.3) for controls (HR = 0.36; 95% CI, 0.04-2.9), whereas 5-year OS was 100% (no events) vs. 96.2% (95% CI, 85.5-99.1; HR could not be estimated).
“The study confirms that pregnant women facing a devastating diagnosis can have an excellent prognosis and can be treated during the second and third trimester of pregnancy with few risks for their unborn children,” Giovanni Codacci-Pisanelli, MD, PhD, assistant professor in the medical oncology, fertility and procreation unit at the European Institute of Oncology in Rome, and Giuseppe Cimino, MD, physician in the department of pediatrics at the University of Rome, wrote in an accompanying editorial. “We must reassure patients facing the devastating diagnosis of cancer during pregnancy, one of the most delicate and exciting experiences of a woman’s life. And we should be grateful to all those women who participated in the study and accepted treatment during pregnancy, wondering every day if they made the right choice for themselves and for their baby. To them, we can now say that they did make the right choice.”
The study’s retrospective design served as a key limitation, according to researchers.
“We will continue to collect data on more pregnant women with sufficient follow-up data, allowing us to answer questions in other tumor types,” Amant told HemOnc Today. “We will also continue to follow children who were prenatally exposed to cancer drugs in order to document their health.” – by Jennifer Southall
For more information:
Frédéric Amant, MD, PhD, can be reached at the Netherlands Cancer Institute, 1066 CX Amsterdam, Netherlands; email: f.amant@nki.nl.
Disclosures: The study was funded by the European Research Council, Research Foundation - Flanders and Charles University Ministry of Health of the Czech Republic. Amant reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Cimino and Codacci-Pisanelli report no relevant financial disclosures.
Perspective
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Ann H. Partridge, MD, MPH
Cancer during pregnancy can be a very challenging medical and psychosocial situation. Care must be paid not only to the maternal disease and risks and benefits of treatment for the mother, but to the potential risks to the fetus of in utero exposure to treatment. A multidisciplinary team is critical, with expertise in cancer treatment and neonatal care, as well as psychosocial care to support the patient and her loved ones in decision-making.
Over the years, we have learned that a number of chemotherapeutic agents can be given safely during the second and third trimester of pregnancy, with careful monitoring of mother and fetus. These data are reassuring for the small number of women who will be diagnosed with cancer during pregnancy. Future research remains necessary, particularly with careful attention to age of gestation at delivery, generally making every effort to deliver as close to term as possible to minimize fetal outcomes associated with prematurity, as well as to understand any long-term effects on the progeny.
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