Hematologic Cancer in Pregnancy…. to Terminate or Not?   Leave a comment

Hematologic cancer in pregnancy despite being rare poses a substantial risk to both mother and fetus.  The primary goal of treatment is to preserve the mother’s health; it should focus on her survival while minimizing treatment-related toxic effects on the fetus. Hematologic cancers are a heterogeneous group of malignancies that differ in their course and management, irrespective of pregnancy.  Pregnancy termination is often advisable at early stages, allowing delivery of adequate therapy.

Hodgkin’s lymphoma is the most common hematologic cancer that occurs during pregnancy, followed by non-Hodgkin’s lymphoma and acute leukemia. Diagnosing these malignancies can be challenging because of the overlap between disease and pregnancy-related symptoms, and the limitations of imaging. Active management of indolent lymphomas can often be postponed until after delivery without adversely affecting the mother or fetus. However, patients with highly aggressive lymphoma that requires intensive chemotherapy, which often includes methotrexate, should be advised to terminate the pregnancy early  because the goal is to save the mother’s life. The diagnosis and management of a hematologic malignancy during pregnancy present ethical and therapeutic challenges.

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