Avilés Agustin, Nambo Maria-Jesus, Neri Natividad
Oncology Research Unit, Oncology Hospital National Medical Center, IMSS, México D.F. MEXICO.
Mediterr J Hematol Infect Dis. 2018 Jan 1;10(1):e2018006. doi: 10.4084/MJHID.2018.006. eCollection 2018.
To assess maternal and fetal outcome of women and newborns who received chemotherapy during pregnancy to treat Hodgkin lymphoma (HL)in early stages (IA, IIA), we performed a retrospective analysis of a cohort of 44 pregnant women with HL and early stages, diagnosed and treated between 1988 to 2013, at a tertiary reference cancer center.
We analyzed data on HL characteristics and treatment, with a particular attention to maternal and fetal complications; in children, we performed a longer follow-up to detect any anomaly in physical development, scholar performance, psychological, cardiac, neurological function, and intelligence tests.
Median age was 29.4 (range 21-37) years; Most patients were stage IIA (86%), had M a bulky mediastinal disease (78%) and 60% had > 3 nodal sites involved; thus these patients were considered to have a not favorable condition. Abortion was refused when it was proposed. All patients received chemotherapy during pregnancy; ABVD (adryamicin, bleomycin, vinblastine, and dacarbazine) at standard doses and schedule, even during the first trimester. Radiotherapy, when indicated, was administered after delivery in 39 patients. No obstetrical complications were observed, delivery occurred between 33 to 36 weeks in 10 cases (22%); and >37 weeks in 34 cases (87%). Four newborns were low-weight: 2012 g median (range 1750 - 2350 g). No clinical malformations were observed, and development of newborns was physiological without evidence of cardiac and neurological damage, behavior, intelligence, and scholar attendance were normal. At median follow-up range of 120.4 (48-299) months, the progression-free survival and overall survival of patients were 95% and 93%respectively.
Combined chemotherapy, as initial therapy appears to be the best approach in this setting of patients, with an excellent outcome to both mothers and children. If radiotherapy is necessary, it could be administered after delivery.
为评估孕期接受化疗以治疗早期（IA、IIA期）霍奇金淋巴瘤（HL）的妇女及新生儿的母婴结局，我们对1988年至2013年期间在一家三级癌症中心确诊并接受治疗的44例早期HL孕妇队列进行了回顾性分析。
我们分析了HL的特征及治疗数据，尤其关注母婴并发症；对于儿童，我们进行了更长时间的随访，以检测身体发育、学业表现、心理、心脏、神经功能及智力测试方面的任何异常。
中位年龄为29.4岁（范围21 - 37岁）；大多数患者为IIA期（86%），有巨大纵隔疾病（78%），60%有超过3个淋巴结部位受累；因此这些患者被认为病情不佳。当提议流产时被拒绝。所有患者在孕期均接受了化疗；采用标准剂量和方案的ABVD（阿霉素、博来霉素、长春花碱和达卡巴嗪），即使在孕早期。如有指征，39例患者在分娩后接受了放疗。未观察到产科并发症，10例（22%）在33至36周分娩；34例（87%）在37周以上分娩。4例新生儿体重低：中位体重2012 g（范围1750 - 2350 g）。未观察到临床畸形，新生儿发育正常，无心脏和神经损伤证据，行为、智力及学业表现正常。在中位随访时间120.4个月（48 - 299个月）时，患者的无进展生存率和总生存率分别为95%和93%。
联合化疗作为初始治疗似乎是这类患者的最佳方法，对母亲和儿童均有良好结局。如有必要进行放疗，可在分娩后进行。
