McLain C R
Clin Obstet Gynecol. 1974 Dec;17(4):185-94. doi: 10.1097/00003081-197412000-00013.
For clinical consideration, leukemia in association with pregnancy can be divided into acute and chronic forms. Maternal mortality in acute leukemia is 100%, and in the chronic form it is 36.5%. Perinatal mortality is 34-36% in acute leukemia and 16.2% in chronic leukemia. The incidence of postpartum hemorrhage is 15-19%; however, in a recent study it was 83%. Chemotherapy and irradiation usually do not produce gross abnormalities of the fetus if given only during the second and third trimesters; however, the subsurface genetic damage that may be done and new mutants that may be produced are unknown. Caution must be used in radiation therapy because of possible late carcinogenic effects and increase in subsequent mortality and leukemia in infants exposed to radiation in utero. Transmission of leukemia from the mother to the fetus is rare. The main objective in management is to maintain the disease in remission long enough to obtain an infant that will survive outside of the uterine environment. The liberalization of abortion, improved methods of birth control, and the improvement in survival rates with new drug combinations and immunotherapy may make the association of leukemia and pregnancy even more rare.
从临床角度考虑，妊娠合并白血病可分为急性和慢性两种类型。急性白血病的孕产妇死亡率为100%，慢性白血病为36.5%。急性白血病的围产期死亡率为34 - 36%，慢性白血病为16.2%。产后出血的发生率为15 - 19%；然而，最近一项研究显示这一比例为83%。如果仅在妊娠中期和晚期进行化疗和放疗，通常不会导致胎儿出现明显异常；然而，可能造成的潜在基因损伤以及可能产生的新突变尚不清楚。由于可能存在迟发性致癌效应，以及增加子宫内接受辐射的婴儿随后的死亡率和患白血病的风险，因此放疗必须谨慎使用。白血病从母亲传给胎儿的情况很少见。治疗的主要目标是使疾病缓解足够长的时间，以获得能在子宫外存活的婴儿。堕胎政策的放宽、节育方法的改进，以及新药联合疗法和免疫疗法使存活率提高，这些可能会使白血病与妊娠的关联更加罕见。
