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General Updates | Acute leukemia during pregnancy: approaching treatment decisions in each trimester
Daan Dierickx, MD, PhD, KU Leuven and University Hospitals Leuven, Leuven, Belgium, discusses the approach to managing acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) during pregnancy, highlighting the need to consider termination in the first trimester due to the urgent nature of the disease. Prof. Dierickx emphasizes the importance of managing maternal coagulation disorders and collaborating with gynecologists to determine the optimal timing of delivery and chemotherapy administration to ensure the health of the mother and a safe birth. This interview took place virtually.
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Transcript
So if it’s in the first trimester, I think termination of the pregnancy should be considered because this is often, as you say, an urgent situation. So we need to treat it immediately often. So if it’s in the first trimester, it’s very difficult. And often acute leukemia is often not diagnosed based on the NIPT test, but because the patient has complaints...
So if it’s in the first trimester, I think termination of the pregnancy should be considered because this is often, as you say, an urgent situation. So we need to treat it immediately often. So if it’s in the first trimester, it’s very difficult. And often acute leukemia is often not diagnosed based on the NIPT test, but because the patient has complaints. So for lymphoma, it’s often diagnosed with the NIPT test, which is at the start of the second trimester. For acute leukemia, if it’s in the first trimester, termination of pregnancy is often recommended.
From the second trimester on, we can give the classical chemotherapy, not the new targeted therapy, which is not considered safe in those patients, but we can give most of the classical chemotherapy. But we have to be careful that acute leukemia is associated with some coagulation disorders. So first, you need to correct those coagulation disorders, whether you go to chemotherapy or whether you go to termination of pregnancy. You really need to correct those coagulation problems because otherwise, it can lead to fatal bleeding disorders, for example, in the mother. And then you can give the chemotherapy. But we have to be careful because chemotherapy causes an increase of red blood cells, white blood cells, platelets. And this is a situation in which you are not going to perform a delivery. So we really need to collaborate with the gynecologist to be sure that the timing of delivery is outside of that window of chemotherapy so for example if the diagnosis is at 33 weeks we will probably first go to delivery and then give the chemotherapy. If the diagnosis is at 24 weeks we can give the chemotherapy, which lasts for four or five weeks, and then we have to see if we can give a second course or if we have to go to the delivery of the pregnant woman.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
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