Stillbirth in week 19 of pregnancy followed by maternal death as a consequence of refused chemotherapy for non-hodgkin's lymphoma--significance of adjuvant chemotherapy in women of reproductive age.
BACKGROUND
Due to rising cure rates in cancer, the question of preserving fertility in young female patients becomes more important. Especially in lymphomas, incidence and long-time survival have increased. Hematologists and gynecologists have to treat more and more female patients who wish to become pregnant despite their disease and/or after finishing treatment.


METHODS
We report on a 28-year-old patient with highly malignant non-Hodgkin's lymphoma (peripheral T cell lymphoma, Ann Arbor stage IV) and main manifestation at the gastric antrum, with a distinct wish for becoming pregnant. Chemotherapy was strongly recommended to her, but she refused. After she had conceived, the disease recurred, followed by stillbirth in week 19 of gestation and death due to gastric perforation and septic shock.


CONCLUSIONS
Facing the risk of sterility after chemotherapy should not induce patients to refuse chemotherapy and risk their lives. Treatment of young female cancer patients should therefore always include a thorough discussion about other ways of preserving fertility for the time after treatment. Such strategies exist, although their success is still limited and not every patient is eligible for them.
Department of Obstetrics and Gynecology, Technical University of Munich, Germany. evelyn.hauenstein@web.de
Evelyn
E
Hauenstein
Stefan
S
Seidl
Karl T M
KT
Schneider
Thorsten
T
Fischer
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use / Q000633:toxicity*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000633:toxicity; D004317:Doxorubicin / Q000008:administration & dosage / Q000633:toxicity; D017809:Fatal Outcome; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced* / Q000517:prevention & control; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage / Q000633:toxicity; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D011262:Pregnancy Trimester, Second; D011706:Pyloric Antrum / Q000473:pathology; D012422:Rupture, Spontaneous; D012772:Shock, Septic / Q000473:pathology; D050497:Stillbirth; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D013275:Stomach Rupture / Q000469:parasitology; D016312:Treatment Refusal; D014750:Vincristine / Q000008:administration & dosage / Q000633:toxicity
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone