Data could guide decisions on treatment of relapsed/refractory lymphoma during pregnancy
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Key takeaways:
- Of 23 women with relapsed/refractory disease, five chose to initiate treatment during pregnancy due to life-threatening conditions.
- The women had 19 live births, the majority of which were vaginal deliveries.
Patients diagnosed with relapsed or refractory lymphoma during pregnancy demonstrated a high rate of OS but low PFS rate, according to study results published in Blood Advances.
Researchers hypothesized that the reason for the low PFS rate among the study population may be due to postponement of treatment until after pregnancy.
Rationale and methodology
Cancer complicates approximately one in 1,000 pregnancies, and lymphoma is the most common hematologic malignancy presenting during pregnancy, Andrew M. Evens, DO, MBA, MSc, associate director of clinical services at Rutgers Cancer Institute of New Jersey, told Healio.
“We and others have published data of cases of newly diagnosed lymphoma during pregnancy,” Evens continued. “However, there is a near complete absence of published data regarding the presentation, management, and maternal and neonatal outcomes for patients with relapsed or refractory lymphoma that occurs during pregnancy. When facing this dilemma several years ago with two patients at Rutgers Cancer Institute of New Jersey, there were no data available in the literature to guide decision making. Thus, we collaborated with 10 cancer centers across the world to gather similar cases and information.”
The retrospective analysis included 23 women diagnosed with relapsed or refractory lymphoma at a median of 20 weeks’ gestation.
Researchers reported median time from initial diagnosis to relapse of 38 months (median patient age at relapse, 31 years). Eighteen women had Hodgkin lymphoma, two had peripheral T-cell lymphoma, one had diffuse large B-cell lymphoma, one had follicular lymphoma and one had marginal zone lymphoma.
“Therapy during pregnancy was deferred in the majority of patients, while five women were treated antenatally due to the life-threatening nature of the disease and presentation earlier in the pregnancy,” Evens said. “One patient was treated with a targeted checkpoint inhibitor throughout most of the second and third trimester, which we previously reported.”
Findings
Overall, patients experienced 19 live births, the majority of which (68%) were vaginal deliveries. More than half of live births were preterm (median gestation, 36 weeks).
In addition, 39% of patients underwent transplantation postpartum.
At 37 months’ follow-up, Evens and colleagues reported a 3-year PFS rate of 24% and 3-year OS rate of 83%.
“Overall, there were few acute obstetrical or neonatal complications, including cases with use of antenatal therapy,” Evens said.
Implications
The findings should help inform the challenging and highly individualized decision-making of cancer during pregnancy, in particular among patients with relapsed or refractory disease, Evens told Healio.
“The treatment options and choices for patients with relapsed or refractory lymphoma are often quite different than with newly diagnosed lymphoma,” he said. “It is important to highlight that an overarching goal of cancer during pregnancy should be to take the gestation to full term at 37 weeks or beyond. It is generally not recommended to induce preterm delivery so that treatment may be initiated.
“Previously published data of patients with cancer showed that preterm delivery can significantly adversely affect the child’s cognitive scores later in life,” he added. “It is critical to establish close collaboration across multiple medical disciplines, especially maternal fetal medicine in these cases.”
Evens said that continued research of these uncommon and complex cancer cases is needed.
“There are ongoing national and global efforts to study pregnancy during cancer, including the consideration of clinical trials with new treatment agents,” he said. “In addition, organizations such as the International Network on Cancer, Infertility and Pregnancy [INCIP], an international collaborative, promotes research on cancer in pregnancy aiming to increase knowledge among health care providers and the general public.”
References:
- Farooq F, et al. Blood Adv. 2023;doi:10.1182/bloodadvances.2023010090.
- New data informs treatment of blood cancer during pregnancy (press release). Available at: https://www.hematology.org/newsroom/press-releases/2023/new-data-informs-treatment-of-blood-cancer-during-pregnancy. Published June 1, 2023. Accessed June 16, 2023.
For more information:
Andrew M. Evens, DO, MBA, MSc, can be reached at ae378@cinj.rutgers.edu.
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