Non-hodgkin’s lymphoma during pregnancy

The coexistence of non-Hodgkin’s lymphoma (NHL) and pregnancy is a rare event [1]. However, the occurrence of NHL during pregnancy might increase due to evidence suggesting a high incidence of AIDS-related NHL in younger patients in developing countries [2]. The management of the pregnant woman with NHL is a challenge to the physician because it may be associated with harmful effects on the fetus. On the other hand, the most common histological NHL subtypes during pregnancy are aggressive, albeit often curable; however, they can be rapidly progressive if not treated properly. Hence, management of the pregnant woman with NHL should be multi-disciplinary to optimize the mother’s chance for cure and allow delivery of a healthy child. Diagnosis and staging For data regarding the diagnosis and staging of lymphoma, the reader is referred to the chapter on Hodgkin's lymphoma. Treatment Indolent NHL Indolent NHL includes follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, which are extremely rare during pregnancy. The indolent NHL subtypes are characterized by a slow clinical course, and because they are not curable with standard chemotherapy, treatment is usually delayed until the patient is symptomatic. Therefore, administration of chemotherapy during the first trimester is usually unnecessary. Most patients can be followed closely without therapy until delivery. When treatment is indicated, the CVP regimen, which is actually CHOP without doxorubicin is at least as safe and may be administered during the second and third trimesters. There are no reports regarding treatment with fludarabine during pregnancy, however, because anti-metabolites tend to be more teratogenic than other anticancer drugs, its use should be avoided if possible. The use of radiolabeled monoclonal antibodies is contraindicated due to high fetal radiation exposure.