Managing Leukemia during pregnancy

Pregnancy-associated leukemia occurs in approximately 1 in 75,000-100,000 pregnancies. This low incidence precludes the conduct of large, prospective, controlled trials. Data are largely based on retrospective series and case reports, making evidence-based decisions difficult. Treatment of the pregnant woman with leukemia may be associated with adverse fetal outcomes. Administration of chemotherapy during the first trimester is associated with an increased risk for congenital malformations. Therefore, acute leukemia diagnosed during the first trimester mandates a strong recommendation for pregnancy termination, followed by initiation of induction therapy. When leukemia is diagnosed later in pregnancy, standard management approaches similar to those in nonpregnant patients can be used, and pregnancy termination is usually not required. Patients diagnosed with chronic myeloid leukemia (CML) during pregnancy can usually be managed with interferon alpha to decrease tumor load. Many patients with established CML and a sustained complete molecular response prior to conception may be followed without treatment throughout the pregnancy. In the rare case of chronic lymphocytic leukemia (CLL) during pregnancy, treatment can usually be delayed until after delivery.