Treatment of acute and chronic leukemia during pregnancy

Leukemia occurs very rarely during pregnancy. Although the epidemiology of pregnancy-associated leukemia has never been studied, the estimated prevalence is approximately 1 in 100,000 pregnancies. The majority of cases are acute leukemia, of which two-thirds are myeloblastic (AML) and one-third are lymphoblastic (ALL). Chronic myeloid leukemia (CML) is found in less than 10% of leukemia cases during pregnancy, and chronic lymphocytic leukemia (CLL) is extremely rare [1]. Acute leukemia Acute leukemia is a violent disease, but it is potentially curable with aggressive chemotherapy regardless of gestational stage. There are indications that postponing or modifying treatment is associated with increased maternal mortality [2-4]. Following a diagnosis of acute leukemia, decisions regarding management of the fetus and the mother must be made promptly and treatment should ensue as quickly as possible. Acute leukemia may have adverse maternal and fetal effects. These include maternal anemia, disseminated intravascular coagulopathy, and decreased exchange of oxygen and nutrients. Only one case of vertical transmission of AML from a mother to a fetus has been reported in the literature [5]. Acute myeloid leukemia The treatment of AML consists of high-dose combination therapy for induction, followed by consolidation therapy with lower doses of chemotherapy. When AML is diagnosed during pregnancy, treatment should not be delayed. The administration of induction chemotherapy during the first trimester must accompany a strong recommendation for pregnancy termination due to the teratogenic effects of chemotherapy.