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General Updates | Key principles and factors guiding treatment decisions for hematologic malignancies during pregnancy
Daan Dierickx, MD, PhD, KU Leuven and University Hospitals Leuven, Leuven, Belgium, discusses the key principles guiding treatment decisions for hematologic malignancies during pregnancy, emphasizing the importance of treating the mother while also considering the impact on fetal health and development. Prof. Dierickx highlights that the trimester of pregnancy significantly influences treatment recommendations, with chemotherapy generally avoided during the first trimester due to the risk of congenital abnormalities, but often possible from the second trimester onwards with careful monitoring. This interview took place virtually.
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Transcript
So our first aim is to treat the mother, of course. If we lose the mother, we will also lose the baby. So the mother is very important. We need to treat the malignancy of the mother as we would treat the malignancy outside the pregnancy context. So that’s very important. But of course, there’s also the baby. So we have a real close collaboration with our colleagues from the gynecological department to try to have the investigations for the baby, the echocardiography on the same day as we provide the chemotherapy to see if everything is okay with the baby, with the mother, and then we can safely deliver the chemotherapy...
So our first aim is to treat the mother, of course. If we lose the mother, we will also lose the baby. So the mother is very important. We need to treat the malignancy of the mother as we would treat the malignancy outside the pregnancy context. So that’s very important. But of course, there’s also the baby. So we have a real close collaboration with our colleagues from the gynecological department to try to have the investigations for the baby, the echocardiography on the same day as we provide the chemotherapy to see if everything is okay with the baby, with the mother, and then we can safely deliver the chemotherapy.
It’s very important because the first trimester is actually the period of the formation of the organs. So all organs are made during the first trimester. And if you give chemotherapy at that time point, there is an increased risk for congenital abnormalities. So we don’t give chemotherapy during the first trimester. After the first trimester, so from the second trimester on, many chemotherapies can be given. Then you have the growing of the organs, but not the formation of the organs. It’s the growing of the organs. And then you can give chemotherapy, not all, but most chemotherapies in a safe way. Of course, we still need to be careful because there is an increased risk for premature birth of the baby or premature contraction in the mother. So we still need to be careful, but it’s perfectly possible to deliver the chemotherapy, for example, for a Hodgkin lymphoma.
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