Disease Description

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DISEASE DESCRIPTION

Since non-Hodgkin's lymphomas (NHL) occur in an older patient population than Hodgkin's disease, this may account for fewer reports of NHL patients with coexisting pregnancy.[1] Magnetic resonance imaging is the preferred tool for staging evaluation to avoid exposure to ionizing radiation.[2] Most of these lymphomas are aggressive and delay of therapy until after delivery appears to have poor outcomes according to anecdotal case series.[1,3-5] Consequently, some investigators favor immediate therapy, even during pregnancy.[5] Children exposed to high-dose doxorubicin-containing combination chemotherapy in utero (especially during the second and third trimester) have been found to be normal subsequently, with follow-up ranging from several months to 11 years.[5-8] There are no data regarding long-term effects on children exposed in utero for most of the chemotherapeutic agents used for treatment of NHL. Termination of pregnancy in the first trimester may be an option to allow therapy for women with aggressive NHL. For some women, early delivery when feasible may minimize or avoid exposure to chemotherapy or radiation therapy. Treatment may be delayed for those women with an indolent NHL.

References:

1. Ward FT, Weiss RB: Lymphoma and pregnancy. Seminars in Oncology 16(5): 397-409, 1989.
2. Nicklas AH, Baker ME: Imaging strategies in the pregnant cancer patient. Seminars in Oncology 27(6): 623-632, 2000.
3. Steiner-Salz D, Yahalom J, Samuelov A, et al.: Non-Hodgkin's lymphoma associated with pregnancy: a report of six cases, with a review of the literature. Cancer 56(8): 2087-2091, 1985.
4. Spitzer M, Citron M, Ilardi CF, et al.: Non-Hodgkin's lymphoma during pregnancy. Gynecologic Oncology 43(3): 309-312, 1991.
5. Gelb AB, van de Rijn M, Warnke RA, et al.: Pregnancy-associated lymphomas: a clinicopathologic study. Cancer 78(2): 304-310, 1996.
6. Aviles A, Diaz-Maqueo JC, Torras V, et al.: Non-Hodgkin's lymphomas and pregnancy: presentation of 16 cases. Gynecologic Oncology 37(3): 335-337, 1990.
7. Moore DT, Taslimi MM: Multi-agent chemotherapy in a case of non-Hodgkin's lymphoma in second trimester of pregnancy. Journal of the Tennessee Medical Association 84(9): 435-436, 1991.
8. Nantel S, Parboosingh J, Poon MC: Treatment of an aggressive non-Hodgkin's lymphoma during pregnancy with MACOP-B chemotherapy. Medical and Pediatric Oncology 18(2): 143-145, 1990.

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