Background Anthracyclines are one of the most important groups of drugs used nowadays in cancer chemotherapy. Chemotherapy is essential in the management of haematological malignancies (HM). When acute leukaemia (AL), aggressive non-Hodgkin’s lymphoma (NHL) or Hodgkin’s lymphoma (HL) occur during pregnancy, chemotherapy is an emergency but foetal risk must be considered.
Purpose To evaluate foetal and maternal outcomes associated with the prescription of anthracyclines in pregnant women with HM.
Materials and Methods Cases of pregnant women with AL, NHL or HL treated by anthracyclines were collected from the Teratogenic Agent Information Centre (TAIC), a French reference centre providing specialised information for clinicians about drug use in pregnancy. A literature review was performed in the PubMed and Embase databases until May 2012 (keywords: pregnancy, acute leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma, cancer chemotherapy, doxorubicin, daunorubicin and idarubicin). Selection criteria of articles: diagnosis of HM and anthracycline prescription during pregnancy, foetal outcome.
Results We report 5 cases of pregnant women with HM (4 AL, 1 HL) treated early in the 3rd trimester by chemotherapy with doxorubicin or daunorubicin at standard dosage. All 5 newborns were normal, but 2 were premature deliveries. 3 maternal outcomes were complete remission (2 unknown). 81 articles were selected, corresponding to 134 pregnant women with AL (95 cases), HL (16) or NHL (23) treated by chemotherapy with daunorubicin (65 cases), doxorubicin (59) or idarubicin (10). Normal neonatal outcomes (100/134) were 88%, 68% and 40% for doxorubicin, daunorubicin and idarubicin respectively, 79%, 77% and 45% for exposure from 3rd (26 cases), 2nd (69) and 1st trimester (11) respectively and 96%, 81% and 68% in NHL, LH and AL respectively. Foetal toxicities were death (20), growth retardation (8) and congenital abnormalities (6). Only idarubicin was associated with foetal cardiomyopathy. 97 maternal outcomes were known with remissions (71 cases) and progressions, relapses or deaths (26 cases).
Conclusions Embryo-foetal toxicity depends on gestational age, anthracycline and HM. 2nd or 3rd trimester exposures were mainly associated with favourable neonatal outcomes. Idarubicin was specifically associated with a risk of foetal cardiotoxicity, probably due to its lipophilic nature, facilitating placental transfer. Unfavourable foetal outcomes were more frequent in AL compared to lymphomas, probably reflecting that chemotherapy can never be delayed till post-partum in AL. It is possible to prescribe anthracyclines for HM in the 2nd and 3rd trimesters of pregnancy with minimal risk to the developing foetus but then the treatment must be conducted by a multidisciplinary team.
No conflict of interest.
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