Treating tumor diseases of the blood system in pregnant women is one of the most complex and challenging tasks in modern medicine. At the V Scientific and Practical Conference “Modern Approaches to the Diagnosis and Treatment of Hematological Diseases” on the 29th of January, Vera Vitalievna Troitskaya, Doctor of Medical Sciences and First Deputy General Director of the National Medical Research Center for Hematology of the Russian Ministry of Health, presented a report on the topic “Treatment of Leukemias During Pregnancy.” The management strategy for such patients is based on the principle of “saving two lives” — that of the mother and the child.
Acute leukemias occur extremely rarely in pregnant women — approximately 1 case per 100,000 pregnancies. The disease is most often diagnosed in the second and third trimesters. Pregnancy can mask the symptoms of leukemia, potentially complicating timely diagnosis. The treatment strategy depends on the gestational age: before 12 weeks, termination of pregnancy is recommended due to the critical period of organogenesis; from 13 to 34 weeks, chemotherapy is administered according to the type of leukemia; after 35 weeks, delivery is performed first, followed by treatment of the underlying disease.
Since 1990, the center has treated over 130 pregnant women with acute leukemias. The median age of the patients was 28 years, and the median gestational age at diagnosis was 26 weeks. The probability of giving birth to a live child for patients with acute leukemia is 78%. Among patients diagnosed with acute leukemia starting from the second trimester, when pregnancy termination for medical reasons is no longer performed, this rate reaches 85%.
Conducted studies on the impact of pregnancy on the course of leukemias allow for the following conclusions. In acute myeloid leukemia, pregnancy does not affect the initial characteristics of the disease but may reduce the effectiveness of therapy. Therefore, all such patients are candidates for allogeneic hematopoietic cell transplantation in first complete remission. In acute promyelocytic leukemia, initial characteristics also do not differ, but treatment results may be worse due to non-compliance (refusal of treatment). After modifying the approach and transitioning to less toxic and shorter regimens, this factor was mitigated. Regarding acute lymphoblastic leukemia, since 2009, pregnant patients have been included in randomized multicenter trials. The results of therapy in pregnant women using modern protocols do not differ from those in non-pregnant women.
Thus, chemotherapy for acute leukemias is possible starting from the second trimester of pregnancy. Its administration to the mother does not significantly affect the condition of the newborn. Managing a pregnant woman with acute leukemia requires the coordinated effort of a multidisciplinary team of doctors and strict adherence to therapeutic programs, which do not differ from those used in the general patient population.
