Mangasarova Ia K, Bariakh E A, Vorob'ev V I, Khlavno A B, Magomedova A U, Shmakov R G, Kravchenko S K
Ter Arkh. 2014;86(7):53-8.
To elaborate a management tactic for pregnant women with primary mediastinal large B-cell lymphoma (PMLBL) and to assess the toxicity of its treatment to the mother and fetus.
In 2004 to 2014, the Hematology Research Center, Ministry of Health of Russia, treated 94 patients with mediastinal large B-cell lymphoma, 7 (7.4%) of them developed the disease during pregnancy. Induction therapy was performed according to the VACOP-B or R-EPOCH program. For consolidation, polychemotherapy (PCT) was made after 3-4 weeks postpartum in accordance with the R+Dexa-BEAM program, followed by radiotherapy (RT) applied to a residual mediastinal mass in a total focal dose of 36 Gy. To assess the nature of the residual mass, positron emission tomography was carried out 1 month following the induction and consolidation cycles of PCT.
PCT was performed in 5 and 2 of the 7 patients diagnosed with PMLBCL in the second and third trimesters according to the VACOP-B and R-EPOCH programs, respectively; for consolidation, PCT was done using the R+Dexa-BEAM regimen in 7 patients: 10 men and 29 women whose ages were 18 to 60 years (median age 30 years); in 5 of the 7 patients, RT was applied to the residual mediastinal region in a total focal dose of 36 Gy. After induction treatment, 4 of 5 the patients in the VACOP-B group achieved partial remission; one of the 5 patients was stated to have disease progression. In the R-EPOCH group, 2 of the 2 patients achieved partial remission. After performing the treatment protocol, an early recurrence was recorded in 1 of the 5 cases in the VACOP-B/Dexa-BEAM/RT group. Effective autologous stem cell transplantation was carried out in patients with disease progression and early recurrence. Seven children (3 boys and 4 girls) were born. Their median body weight was 2182 g (1700 to 3600 g); the median height was 47 cm (40 to 53 cm). Two neonatal infants born to women who had received CT using the R-EPOCH regimen were diagnosed as having intrauterine pneumonia resulting from respiratory distress syndrome, which might be associated with fetal prematurity and the use of rituximab. One baby born to a patient who had been included in the VACOP-B treatment protocol was stated to have superior vena cava at birth. The median follow-up of the patients and born infants was 35 months (15 to 64 months).
Due to the elaborated algorithm for the treatment and management of pregnant women, all the patients are alive without tumor signs and their babies are healthy without signs of development defects and retardation.
阐述原发性纵隔大B细胞淋巴瘤（PMLBL）孕妇的管理策略，并评估其治疗对母亲和胎儿的毒性。
2004年至2014年，俄罗斯卫生部血液学研究中心治疗了94例纵隔大B细胞淋巴瘤患者，其中7例（7.4%）在孕期发病。诱导治疗按照VACOP - B或R - EPOCH方案进行。巩固治疗方面，产后3 - 4周根据R + Dexa - BEAM方案进行多药化疗（PCT），随后对残留纵隔肿块进行放疗（RT），总局部剂量为36 Gy。为评估残留肿块的性质，在PCT诱导和巩固周期后1个月进行正电子发射断层扫描。
7例诊断为PMLBCL的患者中，5例在孕中期、2例在孕晚期分别根据VACOP - B和R - EPOCH方案进行了PCT；巩固治疗时，7例患者使用R + Dexa - BEAM方案进行了PCT：10名男性和29名女性，年龄18至60岁（中位年龄30岁）；7例患者中有5例对残留纵隔区域进行了总局部剂量为36 Gy的RT。诱导治疗后，VACOP - B组5例患者中有4例达到部分缓解；5例患者中有1例病情进展。在R - EPOCH组，2例患者中有2例达到部分缓解。执行治疗方案后，VACOP - B/Dexa - BEAM/RT组5例中有1例出现早期复发。对病情进展和早期复发的患者进行了有效的自体干细胞移植。7名儿童（3名男孩和4名女孩）出生。他们的中位体重为2182 g（1700至3600 g）；中位身高为47 cm（40至53 cm）。接受R - EPOCH方案CT治疗的2名产妇所生新生儿被诊断为因呼吸窘迫综合征导致的宫内肺炎，这可能与胎儿早产和使用利妥昔单抗有关。1名纳入VACOP - B治疗方案的患者所生婴儿出生时被诊断为上腔静脉异常。患者及所生婴儿的中位随访时间为35个月（15至64个月）。
由于制定了针对孕妇的治疗和管理方案，所有患者均存活且无肿瘤迹象，其婴儿健康，无发育缺陷和发育迟缓迹象。
