Acute leukemia in pregnancy: A single institution experience.

Abstract

7040 Background: Acute leukemia is rarely diagnosed during pregnancy. Management of acute leukemia during pregnancy presents a considerable challenge due to limited available data on optimal management including fetal and maternal outcomes. Methods: After approval by the Mayo IRB, 23 cases of acute leukemia diagnosed during pregnancy between 1962 and 2016 were identified using an institutional computerized database. Information was extracted using electronic medical records and paper chart review. Results: The majority of patients (n=18) had acute myeloid leukemia (AML) including 4 with acute promyelocytic leukemia (APL). Five patients had acute lymphoblastic leukemia (ALL). Ten patients were diagnosed in the first trimester (43.4%), 7 in the second trimester (30.4 %) and 6 in the third trimester (26.2%) of pregnancy. Eighteen patients (78%) achieved a complete remission. Approximately 50% (n=11) of pregnancies ended with elective or spontaneous abortions. Fifty percent (2 /4) of patients diagnosed in first or second trimester who delayed chemotherapy greater than 1 week died during induction therapy. Eleven patients received chemotherapy while pregnant (2 in first, 6 in second and 3 in third trimester) which lead to 4 fetal losses and 7 deliveries. The majority of neonates were of low birth weight with one having mild anemia at birth and no detected congenital malformation. At a median follow up of 55 months (range, 8-330) 7 patients (30%) are alive. Table 1 summarizes the maternal and fetal outcomes. Conclusions: Delay in therapy on the basis of fetal well-being may lead to an adverse maternal outcome. Despite higher risk of preterm low birth-weight delivery, in utero exposure to chemotherapy in the second and third trimesters did not increase the risk of fetal malformation. Overall outcomes based on trimester of pregnancy at the time of acute leukemia diagnosis. N=23 First Trimester 0-13 weeks Second Trimester 14-26 weeks Third Trimester 27-40 weeks N 10 7 6 Median time to chemotherapy (range) 11.5 (2-140) days 4 (1-6) days 1 untreated 6 (1-34) days AML 6 4 4 APL 1 2 1 ALL 3 1 1 Elective Termination 5 0 0 Fetal Outcomes N=5 N=7 N=6 Death 3 3 0 Pre-term Delivery 2 2 4 Term Delivery 0 2 2 Disease Outcomes . . . Achieved CR 8 6 4 Durable CR 3 3 2 Relapsed/Refractory 3 1 2 HSCT 3 1 2