Lymphoma occurring during pregnancy

antenatal therapy, complications, and maternal survival in a multicenter analysis.

Andrew M. Evens, Ranjana Advani, Oliver W. Press, Izidore S. Lossos, Julie M. Vose, Francisco J. Hernandez-Ilizaliturri, Barrett K. Robinson, Stavroula Otis, Liat Nadav Dagan, Ramsey Abdallah, Aimee Kroll-Desrosiers, Jessica L. Yarber, Jose Sandoval, Kelley Foyil, Linda M. Parker, Leo I. Gordon, Kristie A. Blum, Christopher R. Flowers, John P. Leonard, Thomas Matthew Habermann & 1 others Nancy L. Bartlett

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Lymphoma is the fourth most frequent cancer in pregnancy; however, current clinical practice is based largely on small series and case reports. In a multicenter retrospective analysis, we examined treatment, complications, and outcomes for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) occurring during pregnancy. Among 90 patients (NHL, n = 50; HL, n = 40), median age was 30 years (range, 18 to 44 years) and median diagnosis occurred at 24 weeks gestation. Of patients with NHL, 52% had advanced-stage versus 25% of patients with HL (P = .01). Pregnancy was terminated in six patients. Among the other 84 patients, 28 (33%) had therapy deferred to postpartum; these patients were diagnosed at a median 30 weeks gestation. This compared with 56 patients (67%) who received antenatal therapy with median lymphoma diagnosis at 21 weeks (P < .001); 89% of these patients received combination chemotherapy. The most common preterm complication was induction of labor (33%). Gestation went to full term in 56% of patients with delivery occurring at a median of 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus antenatal therapy. At 41 months, 3-year progression-free survival (PFS) and overall survival (OS) for NHL were 53% and 82%, respectively, and 85% and 97%, respectively, for HL. On univariate analysis for NHL, radiotherapy predicted inferior PFS, and increased lactate dehydrogenase and poor Eastern Cooperative Oncology Group performance status (ECOG PS) portended worse OS. For HL patients, nulliparous status and "B" symptoms predicted inferior PFS. Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.

Original languageEnglish (US)
Pages (from-to)4132-4139
Number of pages8
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume31
Issue number32
StatePublished - Nov 10 2013

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Lymphoma
Mothers
Pregnancy
Survival
Hodgkin Disease
Non-Hodgkin's Lymphoma
Disease-Free Survival
Therapeutics
Combination Drug Therapy
Induced Labor
First Pregnancy Trimester
L-Lactate Dehydrogenase
Birth Weight
Postpartum Period
Radiotherapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evens, A. M., Advani, R., Press, O. W., Lossos, I. S., Vose, J. M., Hernandez-Ilizaliturri, F. J., ... Bartlett, N. L. (2013). Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 31(32), 4132-4139.

Lymphoma occurring during pregnancy : antenatal therapy, complications, and maternal survival in a multicenter analysis. / Evens, Andrew M.; Advani, Ranjana; Press, Oliver W.; Lossos, Izidore S.; Vose, Julie M.; Hernandez-Ilizaliturri, Francisco J.; Robinson, Barrett K.; Otis, Stavroula; Nadav Dagan, Liat; Abdallah, Ramsey; Kroll-Desrosiers, Aimee; Yarber, Jessica L.; Sandoval, Jose; Foyil, Kelley; Parker, Linda M.; Gordon, Leo I.; Blum, Kristie A.; Flowers, Christopher R.; Leonard, John P.; Habermann, Thomas Matthew; Bartlett, Nancy L.

In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Vol. 31, No. 32, 10.11.2013, p. 4132-4139.

Research output: Contribution to journalArticle

Evens, AM, Advani, R, Press, OW, Lossos, IS, Vose, JM, Hernandez-Ilizaliturri, FJ, Robinson, BK, Otis, S, Nadav Dagan, L, Abdallah, R, Kroll-Desrosiers, A, Yarber, JL, Sandoval, J, Foyil, K, Parker, LM, Gordon, LI, Blum, KA, Flowers, CR, Leonard, JP, Habermann, TM & Bartlett, NL 2013, 'Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis.', Journal of clinical oncology : official journal of the American Society of Clinical Oncology, vol. 31, no. 32, pp. 4132-4139.
Evens, Andrew M. ; Advani, Ranjana ; Press, Oliver W. ; Lossos, Izidore S. ; Vose, Julie M. ; Hernandez-Ilizaliturri, Francisco J. ; Robinson, Barrett K. ; Otis, Stavroula ; Nadav Dagan, Liat ; Abdallah, Ramsey ; Kroll-Desrosiers, Aimee ; Yarber, Jessica L. ; Sandoval, Jose ; Foyil, Kelley ; Parker, Linda M. ; Gordon, Leo I. ; Blum, Kristie A. ; Flowers, Christopher R. ; Leonard, John P. ; Habermann, Thomas Matthew ; Bartlett, Nancy L. / Lymphoma occurring during pregnancy : antenatal therapy, complications, and maternal survival in a multicenter analysis. In: Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2013 ; Vol. 31, No. 32. pp. 4132-4139.
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abstract = "Lymphoma is the fourth most frequent cancer in pregnancy; however, current clinical practice is based largely on small series and case reports. In a multicenter retrospective analysis, we examined treatment, complications, and outcomes for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) occurring during pregnancy. Among 90 patients (NHL, n = 50; HL, n = 40), median age was 30 years (range, 18 to 44 years) and median diagnosis occurred at 24 weeks gestation. Of patients with NHL, 52{\%} had advanced-stage versus 25{\%} of patients with HL (P = .01). Pregnancy was terminated in six patients. Among the other 84 patients, 28 (33{\%}) had therapy deferred to postpartum; these patients were diagnosed at a median 30 weeks gestation. This compared with 56 patients (67{\%}) who received antenatal therapy with median lymphoma diagnosis at 21 weeks (P < .001); 89{\%} of these patients received combination chemotherapy. The most common preterm complication was induction of labor (33{\%}). Gestation went to full term in 56{\%} of patients with delivery occurring at a median of 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus antenatal therapy. At 41 months, 3-year progression-free survival (PFS) and overall survival (OS) for NHL were 53{\%} and 82{\%}, respectively, and 85{\%} and 97{\%}, respectively, for HL. On univariate analysis for NHL, radiotherapy predicted inferior PFS, and increased lactate dehydrogenase and poor Eastern Cooperative Oncology Group performance status (ECOG PS) portended worse OS. For HL patients, nulliparous status and {"}B{"} symptoms predicted inferior PFS. Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.",
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AU - Evens, Andrew M.

AU - Advani, Ranjana

AU - Press, Oliver W.

AU - Lossos, Izidore S.

AU - Vose, Julie M.

AU - Hernandez-Ilizaliturri, Francisco J.

AU - Robinson, Barrett K.

AU - Otis, Stavroula

AU - Nadav Dagan, Liat

AU - Abdallah, Ramsey

AU - Kroll-Desrosiers, Aimee

AU - Yarber, Jessica L.

AU - Sandoval, Jose

AU - Foyil, Kelley

AU - Parker, Linda M.

AU - Gordon, Leo I.

AU - Blum, Kristie A.

AU - Flowers, Christopher R.

AU - Leonard, John P.

AU - Habermann, Thomas Matthew

AU - Bartlett, Nancy L.

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N2 - Lymphoma is the fourth most frequent cancer in pregnancy; however, current clinical practice is based largely on small series and case reports. In a multicenter retrospective analysis, we examined treatment, complications, and outcomes for Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) occurring during pregnancy. Among 90 patients (NHL, n = 50; HL, n = 40), median age was 30 years (range, 18 to 44 years) and median diagnosis occurred at 24 weeks gestation. Of patients with NHL, 52% had advanced-stage versus 25% of patients with HL (P = .01). Pregnancy was terminated in six patients. Among the other 84 patients, 28 (33%) had therapy deferred to postpartum; these patients were diagnosed at a median 30 weeks gestation. This compared with 56 patients (67%) who received antenatal therapy with median lymphoma diagnosis at 21 weeks (P < .001); 89% of these patients received combination chemotherapy. The most common preterm complication was induction of labor (33%). Gestation went to full term in 56% of patients with delivery occurring at a median of 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus antenatal therapy. At 41 months, 3-year progression-free survival (PFS) and overall survival (OS) for NHL were 53% and 82%, respectively, and 85% and 97%, respectively, for HL. On univariate analysis for NHL, radiotherapy predicted inferior PFS, and increased lactate dehydrogenase and poor Eastern Cooperative Oncology Group performance status (ECOG PS) portended worse OS. For HL patients, nulliparous status and "B" symptoms predicted inferior PFS. Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.

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