Department of Pharmacy, King Fahad Medical City, Riyadh, Saudi Arabia.
Maternal Fetal Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia.
BMC Pregnancy Childbirth. 2019 Oct 31;19(1):394. doi: 10.1186/s12884-019-2522-1.
The management of Acute Myeloid Leukemia (AML) during pregnancy remains challenging as both the maternal and fetal outcomes should be considered. Several reports suggested that chemotherapy can be administered safely during the second and third trimester of pregnancy. However, the use of 5-azacytidine presents limitation due to lack of data.
A 28-years-old woman in the 26th week of gestation diagnosed with FLT3/ITD-mutated AML, complete remission was induced by Daunorubicin and Cytarabine, and subsequently with 5-azacytidine (75 mg/m2 daily for 7 days) with no fetal hematological or toxicity issues. Fetal ultrasound showed no aberrant morphology. Fetal size below the 5th percentile with normal umbilical artery dopplers, normal middle cerebral artery dopplers and ductus venosus doppler. Three weeks post 5-azacytidine, the team determined the most appropriate time for delivery after balancing the risks of prematurity and prevention of disease relapse since patient in hematological remission. The patient underwent elective lower segment caesarian section and had a baby girl delivered at 35 weeks of gestation weighing 1670 g without apparent anomalies.
Treatment using 5-azacytadine during last trimester of pregnancy resulted in no major fetal and maternal complications. These findings concluded that 5-azacytadine during the third trimester of pregnancy seems to be safe however, potential risks of this agent should be considered.
急性髓系白血病（AML）在妊娠期间的管理仍然具有挑战性，因为需要同时考虑母婴的结局。有几项报告表明，在妊娠的第二和第三孕期可以安全地给予化疗。然而，由于缺乏数据，5-氮杂胞苷的使用存在局限性。
一名 28 岁女性，妊娠 26 周时诊断为 FLT3/ITD 突变的 AML。用柔红霉素和阿糖胞苷诱导完全缓解，随后用 5-氮杂胞苷（75mg/m2，每日 7 天）治疗，无胎儿血液学或毒性问题。胎儿超声未见异常形态。胎儿大小低于第 5 百分位，脐动脉多普勒、大脑中动脉多普勒和静脉导管多普勒正常。5-氮杂胞苷治疗 3 周后，团队在平衡早产风险和预防疾病复发之间，确定了最适合分娩的时间，因为患者处于血液学缓解期。患者行选择性下段剖宫产术，于妊娠 35 周时分娩一女婴，体重 1670g，无明显异常。
在妊娠晚期使用 5-氮杂胞苷治疗未导致胎儿和母体出现重大并发症。这些发现表明，妊娠晚期使用 5-氮杂胞苷似乎是安全的，但应考虑该药物的潜在风险。
