Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review
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ORIGINAL ARTICLE
Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review Yi‑Wei Li1,2 · Yang‑Feng Xu3 · Wei Hu2 · Shen‑Xian Qian1 · Can Chen1 Received: 2 May 2020 / Revised: 16 June 2020 / Accepted: 23 June 2020 © Japanese Society of Hematology 2020
Abstract Management of acute myeloid leukemia during pregnancy (P-AML) is a challenging endeavor with limited evidence-based information available. To truly achieve the goal of improving P-AML patients, additional evidence-based research is necessary. We retrospectively reviewed cases of 17 patients diagnosed with P-AML, including seven for acute promyelocytic leukemia (APL) from January 2012 to June 2019. Among the non-APL, 90% patients (9/10) ended pregnancy prior to induction chemotherapy. The median intervals between diagnosis and start of chemotherapy were 5 days (range 1–14 days). Four patients elected to delay chemotherapy by more than one week. Of the seven APL patients, six received all-trans retinoic acid (ATRA) before the diagnostic molecular results. Five patients underwent cesarean sections (CS) and all newborns were alive (four preterm and one full-term deliveries). Overall, approximately 94% of the patients (16/17) are currently alive in remission. To treat P-AML patients in a safer manner, balancing the risk of progressing to advanced disease and proceeding with pregnancy is required. We consider a slight delay (less than 14 days) in the termination of pregnancy may not differ the prognosis to patients with non-APL. For APL, patients will benefit from prompt administration of ATRA for highly suspected cases. Keywords Acute myeloid leukemia · Pregnancy · Chemotherapy
Introduction Due to the trend of increased maternal age, more patients are being diagnosed with acute leukemias (AL) during pregnancy, with an estimated rate of 1 in 75,000–100,000 pregnancies and the majority of these cases are of myeloid origin [1–3]. Although exciting advances in multi-agent
* Shen‑Xian Qian [email protected] * Can Chen [email protected] 1
Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 216 Huansha Road, Hangzhou, Zhejiang 310006, People’s Republic of China
2
Department of Intensive Care Unit, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
3
Department of Obstetrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, HangZhou, People’s Republic of China
chemotherapy, stem cell transplantation, and supportive care guidelines have been made in the treatment of acute myeloid leukemia (AML), especially for acute promyelocytic leukemia (APL), the optimal therapeutic approaches to a patient with AML during pregnancy (P-AML) is still challenging. It is well-known that chemo-based therapy is the first line of AML treatment. In the past several years, some case reports and case series have shown positive outcomes after exposure to che
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