Horowitz Netanel A, Henig Israel, Henig Oryan, Benyamini Noam, Vidal Liat, Avivi Irit
a Department of Hematology & Bone Marrow Transplantation , Rambam Health Care Campus , Haifa , Israel.
b Ruth and Bruce Rappaport Faculty of Medicine , Technion , Haifa , Israel.
Leuk Lymphoma. 2018 Mar;59(3):610-616. doi: 10.1080/10428194.2017.1347651. Epub 2017 Jul 13.
Data regarding clinical characteristics, therapy, maternal and fetal outcomes of pregnancy-associated acute myeloid leukemia (PA-AML) are limited. This study (including 138 cases published between 1955 and 2013) provides comprehensive assessment of these clinical parameters and may serve as a platform for developing management recommendations. Most patients (58%) received anthracycline-cytarabine-based regimens (ACBRs), which were associated with significantly increased complete remission (CR: 91%). Yet, the maternal overall survival (OS: ∼30%) was relatively low, probably reflecting reduced application of risk-adapted consolidation and allogeneic stem cell transplantation (allo-SCT). Fetal exposure to ACBRs resulted in a live birth rate of 87%, with complications (16%) diagnosed only in chemotherapy-subjected neonates. This study demonstrates safety and efficacy of ACBRs during pregnancy. Therapy and delivery schedule should allow early referral of high-risk patients to allo-SCT. Generation of a pool of high-quality data on PA-AML could contribute to providing evidence-based therapy and lead to improved maternal and fetal survival.
关于妊娠相关急性髓系白血病（PA-AML）的临床特征、治疗、母婴结局的数据有限。本研究（包括1955年至2013年间发表的138例病例）对这些临床参数进行了全面评估，可作为制定管理建议的平台。大多数患者（58%）接受了基于蒽环类药物-阿糖胞苷的方案（ACBRs），该方案与完全缓解率显著提高（CR：91%）相关。然而，母亲的总生存率（OS：约30%）相对较低，这可能反映了风险适应性巩固治疗和异基因干细胞移植（allo-SCT）的应用减少。胎儿暴露于ACBRs导致活产率为87%，仅在接受化疗的新生儿中诊断出并发症（16%）。本研究证明了ACBRs在孕期的安全性和有效性。治疗和分娩计划应允许将高危患者尽早转诊至allo-SCT。生成关于PA-AML的高质量数据集有助于提供循证治疗，并改善母婴生存率。
