title: Maternal and Fetal Outcomes After Therapy for Hodgkin or Non-Hodgkin Lymphoma Diagnosed During Pregnancy.
abstract: OBJECTIVE
  The management of lymphoma diagnosed during pregnancy is controversial and has been guided largely by findings from case reports and small series.
  
  
  OBJECTIVE
  To determine maternal and fetal outcomes of women diagnosed with Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) during pregnancy.
  
  
  METHODS
  This retrospective analysis studied a cohort of 39 pregnant women diagnosed with HL and NHL (31 HL and 8 NHL) at a single specialized cancer institution between January 1991 and December 2014.
  
  
  METHODS
  We examined data on disease and treatment characteristics, as well as maternal and fetal complications and outcomes. The Kaplan-Meier method was used to compare progression free survival (PFS) and overall survival (OS) according to receipt of antenatal therapy and other clinical factors. Univariate and multivariate analyses were performed by using Cox proportional hazard regression models to identify potential associations between clinical and treatment factors and survival.
  
  
  RESULTS
  The median (range) age of the 39 women in the patient cohort was 28 (19-38) years; 32 women (82%) had stage I or II disease at diagnosis, and 13 had bulky disease. Three women electively terminated the pregnancy to allow immediate systemic therapy; of the remaining 36 women, 24 received antenatal therapy (doxorubicin based combination chemotherapy in 20 of 24 patients), and 12 deferred therapy until after delivery. Four women experienced miscarriage, all of whom had received antenatal systemic therapy and 2 during the first trimester. Delivery occurred at a median (range) of 37 (32-42) weeks and was no different based on receipt of antenatal (median [range], 37 [33-42] weeks) vs postnatal (median [range], 37 [32-42] weeks) therapy (P = .21). No gross fetal malformations or anomalies were detected. At a median (range) follow-up time of 67.9 (8.8-277.5) months since the diagnosis of lymphoma, 5-year rates of PFS and OS were 74.7% and 82.4%, respectively; these rates did not differ according to timing of therapy. On univariate analysis, bulky disease (>10 cm), extranodal nonbone marrow involvement, and poor performance status (Eastern Cooperative Oncology Group score, ≥2) predicted increased risk of disease progression. On multivariate analysis, extranodal nonbone marrow disease and performance status remained significant for both PFS and OS.
  
  
  CONCLUSIONS
  Systemic therapy given for lymphoma after the first trimester of pregnancy is likely safe and results in acceptable maternal and fetal outcomes.
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Chelsea C
authors.initials: CC
authors.lastname: Pinnix
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Osborne
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Dai
authors.initials: D
authors.lastname: Chihara
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Peter
authors.initials: P
authors.lastname: Lai
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Shouhao
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Mildred M
authors.initials: MM
authors.lastname: Ramirez
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oki
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Frederick B
authors.initials: FB
authors.lastname: Hagemeister
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Alma M
authors.initials: AM
authors.lastname: Rodriguez
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Felipe
authors.initials: F
authors.lastname: Samaniego
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Nathan
authors.initials: N
authors.lastname: Fowler
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Romaguera
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Francesco
authors.initials: F
authors.lastname: Turturro
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Luis
authors.initials: L
authors.lastname: Fayad
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Westin
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Loretta
authors.initials: L
authors.lastname: Nastoupil
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Sattva S
authors.initials: SS
authors.lastname: Neelapu
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Chan Y
authors.initials: CY
authors.lastname: Cheah
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Bouthaina S
authors.initials: BS
authors.lastname: Dabaja
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Milgrom
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Patricia
authors.initials: P
authors.lastname: Horace
authors.affiliation: Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Andrea
authors.initials: A
authors.lastname: Milbourne
authors.affiliation: Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Christine F
authors.initials: CF
authors.lastname: Wogan
authors.affiliation: Department of Radiation Oncology, University of Southern California, Los Angeles.
authors.forename: Leslie
authors.initials: L
authors.lastname: Ballas
authors.affiliation: Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Fanale
mesh_terms: D000028:Abortion, Induced; D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology*; D019468:Disease Management; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008228:Lymphoma, Non-Hodgkin / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult