Kobayashi Shuhei, Biyajima Kyoko, Matsuzawa Shuji, Sakai Kaoko, Kawakami Fumihiro, Kawakami Toru, Nishina Sayaka, Sakai Hitoshi, Fuseya Chiho, Nakazawa Hideyuki
Department of Hematology and Medical Oncology Shinshu University School of Medicine Matsumoto Japan.
Department of Obstetrics and Gynecology Shinshu University School of Medicine Matsumoto Japan.
EJHaem. 2023 Apr 5;4(2):393-400. doi: 10.1002/jha2.682. eCollection 2023 May.
Leukemia may rarely develop in a woman during pregnancy, posing clinical challenges to the patient, fetus, family, and medical staff managing malignancy and pregnancy. We retrospectively analyzed cases of pregnancy-associated leukemia consecutively diagnosed and treated at a local tertiary-care hospital in Nagano, Japan, over the past 20 years. Five cases were identified among 377,000 pregnancies in the area (one in every 75,000 pregnancies), all involving acute leukemia (three acute myelogenous leukemia [AML] and two acute lymphoblastic leukemia [ALL]). The cases were diagnosed in the first trimester ( = 1), second trimester ( = 3), or third trimester ( = 1). There were no apparent pregnancy-associated delays in diagnosing and treating the cases. Three patients underwent induction chemotherapy during pregnancy, two of whom eventually delivered healthy babies. One of the five patients chose abortion before chemotherapy initiation. Two cases showing high-risk features at the diagnosis (AML with an FLT3-ITD mutation [ = 1] and relapsed ALL [ = 1]) eventually died despite consolidative allogeneic hematopoietic stem cell transplantation. Our results suggested that patients with pregnancy-associated acute leukemia can be treated similarly to nonpregnant patients, although pregnancy imposes particular clinical challenges that should be resolved with multidisciplinary care.
白血病在孕期女性中很少发生，这给患者、胎儿、家庭以及负责治疗恶性肿瘤合并妊娠的医护人员带来了临床挑战。我们回顾性分析了过去20年在日本长野一家当地三级医疗医院连续诊断和治疗的妊娠相关白血病病例。在该地区377,000例妊娠中发现了5例（每75,000例妊娠中有1例），均为急性白血病（3例急性髓系白血病[AML]和2例急性淋巴细胞白血病[ALL]）。这些病例在孕早期（=1例）、孕中期（=3例）或孕晚期（=1例）被诊断出来。在诊断和治疗这些病例时没有明显的与妊娠相关的延误。3例患者在孕期接受了诱导化疗，其中2例最终产下健康婴儿。5例患者中有1例在开始化疗前选择了流产。2例在诊断时表现出高危特征的病例（1例伴有FLT3-ITD突变的AML和1例复发性ALL）尽管接受了巩固性异基因造血干细胞移植，最终还是死亡。我们的结果表明，妊娠相关急性白血病患者的治疗方式可与非妊娠患者相似，尽管妊娠带来了特殊的临床挑战，需要通过多学科护理来解决。
