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Management and controversies of classical Hodgkin lymphoma in pregnancy
Author(s) -
Eyre Toby A.,
Lau IJun,
Mackillop Lucy,
Collins Graham P.
Publication year - 2015
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13327
Subject(s) - pregnancy , vinblastine , medicine , dacarbazine , abvd , obstetrics and gynaecology , intensive care medicine , lymphoma , pediatrics , obstetrics , chemotherapy , surgery , vincristine , cyclophosphamide , genetics , biology
Summary The goal of managing classical Hodgkin lymphoma ( cHL ) in pregnancy is to obtain good long‐term outcomes for both the mother and fetus. Given the excellent outcomes outside of pregnancy, the goal of treatment should remain curative. There remains a tension and debate regarding the timing of chemotherapy, the curative nature of such treatment and the timing of delivery. Moreover, the aim during pregnancy should be to minimize fetal toxicity and optimize perinatal outcomes. The management of cHL within pregnancy was covered within the excellent recent British Committee for Standards in Haematology guidelines, but with necessary brevity. By reviewing the literature over the last 30 years, herein we discuss the options for management during each trimester. Critical organogenesis occurs between 2 and 8 weeks post‐conception; during which time the immature fetus is vulnerable to cytotoxic exposure. We discuss the evidence for using ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and single agent vinblastine in the first trimester. cHL presenting in pregnancy raises complex and difficult ethical dilemmas that can cause anxiety for patients, families and physicians. Decision‐making must be multi‐disciplinary and holistic, taking into account the patient's wishes, psycho‐social and religious beliefs and personal circumstances. Clear communication between the haemato‐oncologist, medical obstetrician, nurse specialists, midwives and neonatologists is paramount to a successful outcome.