Maternal and Fetal Outcomes After Therapy for Hodgkin or Non-Hodgkin Lymphoma Diagnosed During Pregnancy - PubMed (original) (raw)
. 2016 Aug 1;2(8):1065-9.
doi: 10.1001/jamaoncol.2016.1396.
Eleanor M Osborne 1, Dai Chihara 2, Peter Lai 2, Shouhao Zhou 3, Mildred M Ramirez 4, Yasuhiro Oki 2, Frederick B Hagemeister 2, Alma M Rodriguez 2, Felipe Samaniego 2, Nathan Fowler 2, Jorge E Romaguera 2, Francesco Turturro 2, Luis Fayad 2, Jason R Westin 2, Loretta Nastoupil 2, Sattva S Neelapu 2, Chan Y Cheah 2, Bouthaina S Dabaja 1, Sarah A Milgrom 1, Grace L Smith 1, Patricia Horace 1, Andrea Milbourne 5, Christine F Wogan 1, Leslie Ballas 6, Michelle A Fanale 2
Affiliations
- PMID: 27227654
- PMCID: PMC7457973
- DOI: 10.1001/jamaoncol.2016.1396
Maternal and Fetal Outcomes After Therapy for Hodgkin or Non-Hodgkin Lymphoma Diagnosed During Pregnancy
Chelsea C Pinnix et al. JAMA Oncol. 2016.
Abstract
Importance: The management of lymphoma diagnosed during pregnancy is controversial and has been guided largely by findings from case reports and small series.
Objective: To determine maternal and fetal outcomes of women diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) during pregnancy.
Design, setting, and participants: This retrospective analysis studied a cohort of 39 pregnant women diagnosed with HL and NHL (31 HL and 8 NHL) at a single specialized cancer institution between January 1991 and December 2014.
Main outcomes and measures: We examined data on disease and treatment characteristics, as well as maternal and fetal complications and outcomes. The Kaplan-Meier method was used to compare progression free survival (PFS) and overall survival (OS) according to receipt of antenatal therapy and other clinical factors. Univariate and multivariate analyses were performed by using Cox proportional hazard regression models to identify potential associations between clinical and treatment factors and survival.
Results: The median (range) age of the 39 women in the patient cohort was 28 (19-38) years; 32 women (82%) had stage I or II disease at diagnosis, and 13 had bulky disease. Three women electively terminated the pregnancy to allow immediate systemic therapy; of the remaining 36 women, 24 received antenatal therapy (doxorubicin based combination chemotherapy in 20 of 24 patients), and 12 deferred therapy until after delivery. Four women experienced miscarriage, all of whom had received antenatal systemic therapy and 2 during the first trimester. Delivery occurred at a median (range) of 37 (32-42) weeks and was no different based on receipt of antenatal (median [range], 37 [33-42] weeks) vs postnatal (median [range], 37 [32-42] weeks) therapy (P = .21). No gross fetal malformations or anomalies were detected. At a median (range) follow-up time of 67.9 (8.8-277.5) months since the diagnosis of lymphoma, 5-year rates of PFS and OS were 74.7% and 82.4%, respectively; these rates did not differ according to timing of therapy. On univariate analysis, bulky disease (>10 cm), extranodal nonbone marrow involvement, and poor performance status (Eastern Cooperative Oncology Group score, ≥2) predicted increased risk of disease progression. On multivariate analysis, extranodal nonbone marrow disease and performance status remained significant for both PFS and OS.
Conclusions and relevance: Systemic therapy given for lymphoma after the first trimester of pregnancy is likely safe and results in acceptable maternal and fetal outcomes.
Conflict of interest statement
Conflict of Interest Disclosures: None reported.
Figures
Figure.. Progression-Free and Overall Survival
A and B, Progression-free survival and overall survival for all 39 patients according to disease histology. C, Progression-free survival and overall survival for all 36 patients that did not terminate pregnancy at the time of diagnosis according to receipt of antenatal therapy. HL indicates Hodgkin lymphoma; NHL, non-Hodgkin lymphoma.
Comment in
- Lymphoma and Pregnancy-Reply.
Pinnix CC, Fanale MA. Pinnix CC, et al. JAMA Oncol. 2017 Apr 1;3(4):567-568. doi: 10.1001/jamaoncol.2016.4848. JAMA Oncol. 2017. PMID: 27978566 No abstract available. - Lymphoma and Pregnancy.
Avilés A, Nambo MJ, Neri N. Avilés A, et al. JAMA Oncol. 2017 Apr 1;3(4):566-567. doi: 10.1001/jamaoncol.2016.5290. JAMA Oncol. 2017. PMID: 27978576 No abstract available.
Similar articles
- Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis.
Evens AM, Advani R, Press OW, Lossos IS, Vose JM, Hernandez-Ilizaliturri FJ, Robinson BK, Otis S, Nadav Dagan L, Abdallah R, Kroll-Desrosiers A, Yarber JL, Sandoval J, Foyil K, Parker LM, Gordon LI, Blum KA, Flowers CR, Leonard JP, Habermann TM, Bartlett NL. Evens AM, et al. J Clin Oncol. 2013 Nov 10;31(32):4132-9. doi: 10.1200/JCO.2013.49.8220. Epub 2013 Sep 16. J Clin Oncol. 2013. PMID: 24043736 - Obstetric and maternal outcomes in patients diagnosed with Hodgkin lymphoma during pregnancy: a multicentre, retrospective, cohort study.
Maggen C, Dierickx D, Lugtenburg P, Laenen A, Cardonick E, Shmakov RG, Bellido M, Cabrera-Garcia A, Gziri MM, Halaska MJ, Ottevanger PB, Van Calsteren K, O'Laughlin A, Polushkina E, Van Dam L, Avivi I, Vandenberghe P, Woei-A-Jin FJSH, Amant F; International Network on Cancer, Infertility and Pregnancy. Maggen C, et al. Lancet Haematol. 2019 Nov;6(11):e551-e561. doi: 10.1016/S2352-3026(19)30195-4. Epub 2019 Sep 26. Lancet Haematol. 2019. PMID: 31564649 - Outcome of Patients With Early-Stage Infradiaphragmatic Hodgkin Lymphoma: A Comprehensive Analysis From the German Hodgkin Study Group.
Sasse S, Goergen H, Plütschow A, Böll B, Eichenauer DA, Fuchs M, Behringer K, Zijlstra JM, Greil R, Markova J, Topp MS, Meissner J, Neubauer A, Baues C, Engert A, Borchmann P, von Tresckow B. Sasse S, et al. J Clin Oncol. 2018 Sep 1;36(25):2603-2611. doi: 10.1200/JCO.2018.78.7192. Epub 2018 Jul 10. J Clin Oncol. 2018. PMID: 29989855 Clinical Trial. - Non-Hodgkin lymphomas in pregnancy: tackling therapeutic quandaries.
Avivi I, Farbstein D, Brenner B, Horowitz NA. Avivi I, et al. Blood Rev. 2014 Sep;28(5):213-20. doi: 10.1016/j.blre.2014.06.004. Epub 2014 Jul 12. Blood Rev. 2014. PMID: 25108745 Review. - The management of hodgkin lymphomas in pregnancies.
Moshe Y, Bentur OS, Lishner M, Avivi I. Moshe Y, et al. Eur J Haematol. 2017 Nov;99(5):385-391. doi: 10.1111/ejh.12956. Epub 2017 Oct 5. Eur J Haematol. 2017. PMID: 28850718 Review.
Cited by
- Immunogenic Cell Death-related Signature Evaluates the Tumor Microenvironment and Predicts the Prognosis in Diffuse Large B-Cell Lymphoma.
Huang S, Liu W, Zhao Q, Chen T, Huang R, Dong L, Nian Z, Yang L. Huang S, et al. Biochem Genet. 2024 Mar 6. doi: 10.1007/s10528-024-10697-6. Online ahead of print. Biochem Genet. 2024. PMID: 38446321 - Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care.
Linkeviciute A, Canario R, Peccatori FA, Dierickx K. Linkeviciute A, et al. Cancers (Basel). 2024 Jan 21;16(2):455. doi: 10.3390/cancers16020455. Cancers (Basel). 2024. PMID: 38275896 Free PMC article. Review. - Pregnancy and Gastric Cancer: A Narrative Review.
Constantin A, Constantin R, Achim F, Socea B, Predescu D. Constantin A, et al. Diagnostics (Basel). 2023 May 29;13(11):1909. doi: 10.3390/diagnostics13111909. Diagnostics (Basel). 2023. PMID: 37296761 Free PMC article. Review. - An international real-world analysis of relapsed/refractory lymphoma occurring during pregnancy.
Farooq F, Brandt JS, Cardonick E, Polushkina E, Vose J, Ahmed S, Ramakrishnan Geethakumari P, Olszewski AJ, Yasin H, Farooq U, Hamad N, Lin Y, Maggen C, Fruscio R, Gziri MM, Steffensen KD, Amant F, Evens AM. Farooq F, et al. Blood Adv. 2023 Sep 26;7(18):5480-5484. doi: 10.1182/bloodadvances.2023010090. Blood Adv. 2023. PMID: 37259563 Free PMC article. No abstract available. - Maternal and perinatal outcomes following a diagnosis of Hodgkin lymphoma during or prior to pregnancy: A systematic review.
Houlihan OA, Buckley D, Maher GM, McCarthy FP, Khashan AS. Houlihan OA, et al. BJOG. 2023 Mar;130(4):336-347. doi: 10.1111/1471-0528.17347. Epub 2022 Dec 12. BJOG. 2023. PMID: 36424902 Free PMC article. Review.
References
- Pavlidis NA. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(4):279–287. - PubMed
- Evens AM, Advani R, Press OW, et al. Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis. J Clin Oncol. 2013;31(32):4132–4139. - PubMed
- Vandenbroucke T, Van Calsteren K, Amant F. Pediatric outcome after maternal cancer diagnosed during pregnancy. N Engl J Med. 2016;374(7):693. - PubMed
- Cheson BD, Fisher RI, Barrington SF, et al.; Alliance, Australasian Leukaemia and Lymphoma Group; Eastern Cooperative Oncology Group; European Mantle Cell Lymphoma Consortium; Italian Lymphoma Foundation; European Organisation for Research; Treatment of Cancer/Dutch Hemato-Oncology Group; Grupo Español de Médula Ósea; German High-Grade Lymphoma Study Group; German Hodgkin’s Study Group; Japanese Lymphorra Study Group; Lymphoma Study Association; NCIC Clinical Trials Group; Nordic Lymphoma Study Group; Southwest Oncology Group; United Kingdom National Cancer Research Institute. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classification. J Clin Oncol. 2014;32(27):3059–3068. - PMC - PubMed
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical