JUN 12, 2023 3:00 AM PDT

Questions Remain on How to Treat Relapsed Lymphoma During Pregnancy

WRITTEN BY: Katie Kokolus

In general, many of us think of cancers as age-related diseases. While cancer and aging are highly interconnected, some cancer scenarios remain entirely unrelated to age. For example, Experts expect nearly 10,000 childhood cancer diagnoses in children aged 15 or younger in the United States this year. Additionally, you may be surprised to learn that cancer complications arise in about 1 in 1,000 women during pregnancy

Breast cancer remains the type of cancer most frequently associated with pregnancy representing nearly 50% of the cases.  While less common, lymphomas can also occur in young women during pregnancy.  Among these malignancies, which develop in the immune cells, Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) account for about 6% and 5% of all pregnancy-related cancers. 

Studies on women developing lymphoma during pregnancy have led doctors to establish treatment management plans to optimize maternal and neonatal outcomes.  However, in rare instances, a lymphoma survivor may experience remission during pregnancy.  Since the published studies account only for women with an initial lymphoma diagnosis, doctors have little information to guide treatment planning in women with relapsed lymphoma during pregnancy.  To investigate this treatment uncertainty, researchers from various centers teamed up to answer some initial questions regarding relapsed/refractory lymphoma during pregnancy.  The researchers recently published the results of their study in Blood Advances

The researchers conducted a retrospective study on patients diagnosed with relapsed lymphoma that occurred during pregnancy.  The women in the study received treatment at ten cancer centers in the United States, Australia, Belgium, Italy, Denmark, and the Netherlands.

The researchers diagnosed a total of 23 cases of lymphoma (average age 31), including 18 HL and 5 NHL.  The NHL cases comprised four diverse NHL subtypes: (peripheral T-cell lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, and marginal zone lymphoma).  On average, the women in the study had 38 months between initial lymphoma diagnosis and relapse.  The average gestation at the time of lymphoma relapse was 22 weeks. 

Four of the patients had an elective or spontaneous abortion, five patients received treatment during pregnancy, and 14 patients deferred treatment until after childbirth.  Four of the five women receiving treatment achieved complete responses.  The remaining patient achieved a transient response followed by progression while still pregnant.  After switching to an immunotherapy regimen in the 2nd and 3rd trimester, she delivered a healthy baby. 

Among the group of women, 19 live births occurred.  Some women who deferred treatment opted for medically induced pre-term delivery in order to begin therapy sooner.  Notably, none of the babies born experienced fetal malformations or late neonatal death.  No significant pregnancy-related complications to the mothers occurred. 

A total of 15 patients had complete follow-ups.  At an average follow-up time of 37 months, two women had died, and relapses occurred in one of four women receiving treatment while pregnant and nine of the eleven women who deferred treatment. 

Further studies, including more patients, will help doctors understand how to best treat patients in these difficult situations. 


Sources: Cancers, J Clin Oncol, JAMA, Blood Adv, Am J Hematol

About the Author
Doctorate (PhD)
I received a PhD in Tumor Immunology from SUNY Buffalo and BS and MS degrees from Duquesne University. I also completed a postdoc fellowship at the Penn State College of Medicine. I am interested in developing novel strategies to improve the efficacy of immunotherapies used to extend cancer survivorship.
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