title: Management of chemotherapy in a pregnancy complicated by a large neuroblastoma.
abstract: BACKGROUND
  The English literature contains infrequent reports of neuroendocrine carcinoma during pregnancy. The chemotherapy for this type of malignancy can cause severe nausea and neutropenia. We used recently developed modalities to ameliorate these side effects.
  
  
  METHODS
  A 22-year-old woman, gravida 4, para 2-0-1-2, presented at 24 weeks' gestation with a complaint of massive lower-extremity edema. Computed tomography scan delineated a large retroperitoneal mass. Biopsy of a small neck mass revealed a poorly differentiated neuroblastoma. A multidisciplinary approach to therapy was undertaken. The patient received cisplatin and etoposide chemotherapy. Complications of the first course included severe neutropenia and nausea with vomiting. Filgrastim and ondansetron were used to treat these complications. She delivered an 1825-g healthy male by cesarean for fetal distress at 35 weeks. No anomalies were noted at birth. Neonatal hematologic indices were normal
  
  
  CONCLUSIONS
  A multidisciplinary approach to rare malignancies is warranted in pregnancy. Filgrastim and ondansetron are effective agents in the treatment of chemotherapy-associated complications. Their use in pregnancy warrants further investigations.
authors.affiliation: Department of Obstetrics and Gynecology, University of South Florida College of Medicine, Tampa, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Arango
authors.forename: C S
authors.initials: CS
authors.lastname: Kalter
authors.forename: S L
authors.initials: SL
authors.lastname: Decesare
authors.forename: J V
authors.initials: JV
authors.lastname: Fiorica
authors.forename: G H
authors.initials: GH
authors.lastname: Lyman
authors.forename: W N
authors.initials: WN
authors.lastname: Spellacy
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects; D005047:Etoposide / Q000009:adverse effects; D005260:Female; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control; D009447:Neuroblastoma / Q000188:drug therapy*; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control; D017294:Ondansetron / Q000627:therapeutic use; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy*; D011994:Recombinant Proteins; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy*; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D017294:Ondansetron; D005047:Etoposide; D000069585:Filgrastim; D002945:Cisplatin