title: Management and controversies of classical Hodgkin lymphoma in pregnancy.
abstract: The goal of managing classical Hodgkin lymphoma (cHL) in pregnancy is to obtain good long-term outcomes for both the mother and fetus. Given the excellent outcomes outside of pregnancy, the goal of treatment should remain curative. There remains a tension and debate regarding the timing of chemotherapy, the curative nature of such treatment and the timing of delivery. Moreover, the aim during pregnancy should be to minimize fetal toxicity and optimize perinatal outcomes. The management of cHL within pregnancy was covered within the excellent recent British Committee for Standards in Haematology guidelines, but with necessary brevity. By reviewing the literature over the last 30 years, herein we discuss the options for management during each trimester. Critical organogenesis occurs between 2 and 8 weeks post-conception; during which time the immature fetus is vulnerable to cytotoxic exposure. We discuss the evidence for using ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and single agent vinblastine in the first trimester. cHL presenting in pregnancy raises complex and difficult ethical dilemmas that can cause anxiety for patients, families and physicians. Decision-making must be multi-disciplinary and holistic, taking into account the patient's wishes, psycho-social and religious beliefs and personal circumstances. Clear communication between the haemato-oncologist, medical obstetrician, nurse specialists, midwives and neonatologists is paramount to a successful outcome.
authors: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: Toby A
authors: TA
authors: Eyre
authors: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: I-Jun
authors: IJ
authors: Lau
authors: Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: Lucy
authors: L
authors: Mackillop
authors: Department of Haematology, Oxford University Hospitals NHS Trust, Oxford, UK.
authors: Graham P
authors: GP
authors: Collins
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003952:Diagnostic Imaging; D019468:Disease Management; D005260:Female; D047109:Fetal Development / Q000187:drug effects / Q000528:radiation effects; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D011256:Pregnancy Outcome; D011264:Pregnancy Trimesters; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hodgkin lymphoma; doxorubicin, bleomycin, vinblastine and dacarbazine; pregnancy; teratogenicity; vinblastine