Acute leukemia during pregnancy: a report on 37 patients and a review of the literature.
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.
Chelghoum
Youcef
Y
Service d'Hématologie Clinique, Hôpital Edouard Herriot, Lyon, France.
Vey
Norbert
N
Raffoux
Emmanuel
E
Huguet
Françoise
F
Pigneux
Arnaud
A
Witz
Brigitte
B
Pautas
Cécile
C
de Botton
Stéphane
S
Guyotat
Denis
D
Lioure
Bruno
B
Fegueux
Nathalie
N
Garban
Frédéric
F
Saad
Hussam
H
Thomas
Xavier
X
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