title: Acute leukemia during pregnancy: a report on 37 patients and a review of the literature.
abstract: BACKGROUND
  Acute leukemia (AL) requiring cytotoxic treatment occurring during pregnancy poses a very difficult therapeutic dilemma.
  
  
  METHODS
  By means of a mail questionnaire, information on a series of 37 patients with a diagnosis of AL during pregnancy was collected from 13 French centers between December, 1988 and November, 2003.
  
  
  RESULTS
  Thirty-one patients had acute myeloid leukemia (AML), and 6 patients had acute lymphoblastic leukemia (ALL). Nine patients were diagnosed during the first trimester, 10 patients were diagnosed during the second trimester, and 18 patients were diagnosed during the third trimester. Fifteen pregnancies ended with therapeutic or spontaneous abortion. There were 13 normal deliveries, including 1 gemellary pregnancy, and 9 Cesarean sections. Twenty-three healthy babies survived from the 37 pregnancies, of whom 15 babies had been exposed to chemotherapeutic agents. A complete remission was achieved in 34 patients. Eleven women had severe extrahematologic complications during the induction remission course. The median disease-free survival (DFS) was not reached, with a 5-year DFS of 54%. Ten patients developed recurrent disease. Overall, 12 of 37 pregnant women died from leukemia.
  
  
  CONCLUSIONS
  Pregnancy does not affect the course of AL. In the first trimester, termination of pregnancy should be discussed because of the potential fetal consequences of chemotherapy. Chemotherapy treatment during the second or third trimester may not require termination of pregnancy, because as remission of AL and delivery of a normal infant are likely to be obtained.
authors.affiliation: Service d'Hématologie Clinique, Hôpital Edouard Herriot, Lyon, France.
authors.forename: Youcef
authors.initials: Y
authors.lastname: Chelghoum
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.forename: Brigitte
authors.initials: B
authors.lastname: Witz
authors.forename: Cécile
authors.initials: C
authors.lastname: Pautas
authors.forename: Stéphane
authors.initials: S
authors.lastname: de Botton
authors.forename: Denis
authors.initials: D
authors.lastname: Guyotat
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Frédéric
authors.initials: F
authors.lastname: Garban
authors.forename: Hussam
authors.initials: H
authors.lastname: Saad
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
mesh_terms: D000208:Acute Disease; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007938:Leukemia / Q000188:drug therapy*; D007951:Leukemia, Myeloid / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters; D012074:Remission Induction