Impact Of Pregnancy On Leukemia

Pregnancy has not been shown to have any consequence on the development, response to treatment, duration of response, or overall survival of acute leukemia.1'8 The complete response rates of 76-77% reported by Reynoso et al. in both pregnant acute myelogenous leukemia (AML) and acute lymphoblastic leukemia (ALL) patients are consistent with those of nonpregnant patients.8 Acute leukemia is fatal if untreated. In all patients, untreated acute leukemia has an overall survival from 2 weeks to 3 months, with deaths most commonly resulting from infection or hemorrhage. Patients not receiving leukemia therapy prior to labor and delivery had approximately 60% perinatal mortality rate in the 1960s-1970s.9 Many of the maternal deaths in leukemic patients during labor and delivery appear to occur in women with either untreated acute leukemia or with disease unresponsive to therapy.8 In the early stages of chronic leukemias, treatment is not essential. If adequate hematologic parameters are maintained without significant bleeding or infection, uncomplicated gestation and delivery can take place with sufficient prenatal care. Leukapheresis may be performed if cytoreduction is necessary.

Acute leukemias, however, are more aggressive and patients require therapy for disease control almost immediately upon diagnosis. There are a few reports of pregnant patients not receiving chemotherapy for acute leukemia. Some patients were diagnosed at delivery or in the last few weeks of gestation and had labor induced before beginning the treatment.10 Catanzarite and Ferguson reviewed fetal outcomes in untreated acute leukemic patients.11

Four patients diagnosed close to delivery (induced or spontaneous deliveries), between 37 and 42 weeks of gestation—all healthy infants One patient diagnosed at 14 weeks—elective abortion with retained placenta and maternal death from hemorrhage

One patient diagnosed at 28 weeks—intrauterine death, maternal demise from intracerebral hemorrhage at 30 weeks One patient diagnosed 1 month prior to conception— disseminated intravascular coagulation (DIC) at 34 weeks with fetal demise within 24 hours

Five of the seven patients died 33 days or less after diagnosis, primarily from hemorrhage and/or infec-tion.11 These examples emphasize the need for early intervention in acute leukemia; pregnant patients require the same aggressive approach as nonpregnant leukemics to attain a goal of complete remission.

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