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The treatment of Hodgkin’s and non-Hodgkin’s lymphoma in pregnancy

From the Department of Internal Medicine A, Meir Medical Center, Kfar, Saba, Israel (DP, ML); Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel (DP, ML); Consortium of Cancer in Pregnancy Experience (CCOPE) (GK, ML); The Motherisk program, Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children and University of Toronto, Canada (GK)

Correspondence: Michael Lishner, Department of medicine, Meir Medical Center, Kfar Saba 44281, Israel. E-mail: michael2{at}clalit.org

ABSTRACT

Lymphoma is the fourth most frequent malignancy diagnosed during pregnancy, occurring in approximately 1:6000 of deliveries. Its occurrence may increase due to the current trend to postpone pregnancy until later in life and the suggested high incidence of AIDS-related non-Hodgkin's lymphoma in developing countries. The relatively rare occurrence of pregnancy-associated lymphoma precludes the conduction of large, prospective studies to examine diagnostic, management and outcome issues. Chemotherapy and radiotherapy during the first trimester are associated with increased risk of congenital malformations and this risk diminishes as pregnancy advances. In the vast majority of cases, when lymphoma is diagnosed during the first trimester, treatment with a standard chemotherapy regimen, following pregnancy termination should be recommended. In the rare patients at low risk, such as those with stage 1 Hodgkin's lymphoma or indolent non-Hodgkin's lymphoma, therapy can be delayed until the end of the first trimester and of embryogenesis while keeping the patients under close observation. When lymphoma is diagnosed during the second and third trimesters, evidence exists suggesting that full-dose chemotherapy can be administered safely without apparent increased risk of severe adverse fetal outcome.

Key words: lymphoma, pregnancy, chemotherapy, fetus, malformations.