Fracchiolla Nicola Stefano, Sciumè Mariarita, Dambrosi Francesco, Guidotti Francesca, Ossola Manuela Wally, Chidini Giovanna, Gianelli Umberto, Merlo Daniela, Cortelezzi Agostino
Oncohematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Via Francesco Sforza, 35, 20122, Milan, Italy.
Gynecology and Obstetrics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy.
BMC Cancer. 2017 Jun 23;17(1):442. doi: 10.1186/s12885-017-3436-9.
Acute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and has an incidence of 1 in 75,000 to 100,000. Its clinical management remains a challenging therapeutic task both for patient and medical team, given to the therapy-attributable risks for mother and fetus and the connected counseling regarding pregnancy continuation.
We provided a review of updated literature and a comprehensive description of five maternal/fetal outcomes of AML cases diagnosed concomitantly to pregnancy and treated at our Institution from 2006 to 2012.
Median age at AML diagnosis was 32 years (31-39). One diagnosis was performed in first trimester and the patient asked for therapeutic abortion before starting chemotherapy. Three cases were diagnosed in second/third trimester; in one case leukemia was diagnosed concomitantly with intrauterine fetal death, while the remaining two patients continued pregnancy and delivered a healthy baby by cesarean section. In only one of these two cases chemotherapy was performed during pregnancy (at 24 + 5 weeks) and consisted of a combination of daunorubicine and cytarabine. Therapy was well tolerated and daily fetus monitoring was performed. After completion of 30 weeks of gestation a cesarean section was carried out; the newborn had an Apgar score of 5/1'-7/5'-9/10', oxygen therapy was temporarily given and peripheral counts displayed transient mild leukopenia. One patient had diagnosis of myelodysplastic syndrome rapidly progressed to AML after delivery. Four out of the 5 described women are currently alive and disease-free. Three children were born and long-term follow-up has shown normal growth and development.
The treatment of AML occurring during pregnancy is challenging and therapeutic decisions should be taken individually for each patient. Consideration must be given both to the immediate health of mother and fetus and to long-term infant health. Our series confirmed the literature data: fetal toxicity of cytostatic therapy clusters during the first trimester; while chemotherapy can be administered safely during second/third trimester and combination of daunorubicin and cytarabine is recommended for induction.
急性髓系白血病（AML）占孕期白血病的三分之二以上，发病率为75000至100000分之一。鉴于治疗对母亲和胎儿的风险以及关于继续妊娠的相关咨询，其临床管理对患者和医疗团队而言仍然是一项具有挑战性的治疗任务。
我们对最新文献进行了综述，并全面描述了2006年至2012年在我们机构诊断为AML并在孕期接受治疗的5例母婴结局。
AML诊断时的中位年龄为32岁（31 - 39岁）。1例在孕早期确诊，患者在开始化疗前要求治疗性流产。3例在孕中/晚期确诊；1例白血病确诊时合并宫内胎儿死亡，其余2例患者继续妊娠并通过剖宫产分娩出健康婴儿。在这2例中，仅1例在孕期（孕24 + 5周）进行了化疗，化疗方案为柔红霉素和阿糖胞苷联合。治疗耐受性良好，并进行了每日胎儿监测。妊娠30周后进行了剖宫产；新生儿阿氏评分分别为5/1分钟 - 7/5分钟 - 9/10分钟，给予了临时氧疗，外周血细胞计数显示短暂轻度白细胞减少。1例患者产后诊断为骨髓增生异常综合征并迅速进展为AML。所描述的5名女性中有4名目前存活且无疾病。3名儿童出生，长期随访显示生长发育正常。
孕期发生的AML治疗具有挑战性，应针对每位患者个体化做出治疗决策。必须同时考虑母亲和胎儿的即时健康以及婴儿的长期健康。我们的系列研究证实了文献数据：细胞毒性疗法的胎儿毒性在孕早期集中；而化疗可在孕中/晚期安全进行，推荐使用柔红霉素和阿糖胞苷联合进行诱导治疗。
