Management of acute leukemia during pregnancy: from the results of a nationwide questionnaire survey and literature survey.

Abstract

In March, 1993, a questionnaire was sent to 362 gynecological and obstetric offices of national, prefectural and municipal hospitals and private university hospitals with 250 beds or more. Answers were collected from 260 institutions. Thus, this study analyzed 39 patients with acute leukemia during pregnancy collected by the questionnaires survey and 64 cases reported in the Japanese literatures during 1975-1993 (total 103 patients). The weeks of pregnancy were defined as the 1st (< 15th week), 2nd (16th-27th week), and 3rd (> 28th week) trimesters. The time of diagnosis of leukemia during pregnancy changed from 25% in the 2nd trimester and 62% in the 3rd trimester during 1975-1984 to 39% and 48% after 1985, respectively. After 1985, the remission rate was 72% in the questionnaire group and 75% in the group from literatures. There was no statistical difference. The 50% survival period was 12 months in the group during 1975-1984, but 25 months in the group after 1985. The survival was significantly longer in the patients whose induction therapy was started before delivery than in those treated after delivery. The results suggest that the treatment for acute leukemia during pregnancy should be initiated as soon as possible after the diagnosis of leukemia, with carefully selected regimens. It is important that the time of delivery should be selected considering the maternal and fetal conditions after consultation with an obstetrician.