A previously healthy 28-year-old woman was diagnosed with Hodgkin's lymphoma, nodular sclerosing type, of the neck and upper mediastinum, stage IIA. She is pregnant, 20 weeks' gestation. The neck involvement is bulky, causing some discomfort to her. Should I treat her now or wait until after she gives birth? She's willing to undergo treatment, but left the decision to me. If I treat her now, what treatment would you recommend?
Response from Avraham Eisbruch, MD
This is a case of a woman in the 20th week of pregnancy who was diagnosed with Hodgkin's lymphoma, bulky disease involving the neck and mediastinum. Treatment approaches include doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy or supradiaphragmatic radiation. Although chemotherapy crosses the placenta and some drugs, especially antimetabolites such as methotrexate, may cause teratogenic effects in the second and third trimesters, including growth retardation, microcephaly, and mental retardation, the drugs in the ABVD regimen seem to be acceptable.
With regard to radiation, there are reports of risks from fetal doses as low as 0.2 Gy in the first trimester, and from somewhat higher doses (1-2 Gy) at 16-25 weeks, including microcephaly. It would be impossible to prevent such a scattered dose to the abdomen following supradiaphragmatic radiation. I therefore recommend considering ABVD chemotherapy now, and involved field consolidative radiation after delivery.
Medscape Oncology. 2002;5(2) © 2002 Medscape
Cite this: Avraham Eisbruch. Bulky-disease Hodgkin's Lymphoma in a Pregnant Woman? - Medscape - Jul 02, 2002.