Pregnancy in leukemia is uncommon, but it has increased due to the progress of combination chemotherapy, increased success of bone marrow transplantation, and a corresponding increase in remission rates and survival of leukemia. All types of leukemia can be combined with pregnancy, with acute leukemia being the most common, followed by chronic granulocytic leukemia, and chronic lymphocytic leukemia being rare. This may be related to the older age of onset of chronic lymphocytic leukemia.
Pregnancy has no effect on the natural course of leukemia. The placenta has been documented to have a barrier effect to prevent leukemia cells from entering the fetus, but because of maternal and infant safety considerations, strong combination chemotherapy is strived for as late in pregnancy or postpartum as possible. And leukemia has adverse effects on the pregnant woman and fetus:
- Anaemia due to leukemia and reduction in functionally normal granulocytes and platelets make for bleeding, infection and even risk of sepsis and cerebral haemorrhage during labour (miscarriage) or puerperium.
- Combined pathological pregnancies, such as placental abruption and hyperemesis gravidarum.
- The incidence of spontaneous fetal abortion, preterm delivery, intrauterine death and fetal growth retardation is significantly higher, about three to four times higher than that of normal pregnancy.
How to treat leukemia in pregnancy?
The prognosis for mother and child depends largely on achieving complete remission of leukemia during pregnancy, so patients with acute leukemia should be treated with chemotherapy after 8 weeks of gestation. The regimen can be similar to that of nonpregnant individuals, especially in acute promyelocytic leukemia, which should be treated early with all-trans retinoic acid to avoid the development of diffuse intravascular coagulation (DIC).
Supportive therapy, including planned, intermittent, and targeted transfusions of component blood to improve maternal hemoglobin and platelet levels, should also be observed in conjunction with chemotherapy. The patient should be well nourished and infections should be actively prevented and controlled, with particular attention to the oral and vaginal areas.
On termination of pregnancy
In acute leukemia, pregnancy does not alter the course of the leukemia and chemotherapy during pregnancy can achieve remission, but cases diagnosed in early and mid-trimester have a high rate of miscarriage and preterm delivery. In the middle and late stages, because chemotherapy has little effect on the fetus and there is no risk of leukemia transmission, the pregnancy can be kept, chemotherapy and better supportive treatment should be given, and the drug should be stopped for a short time before delivery. In short, it should be fully weighed according to the prevailing condition, the pregnancy and the patient’s urgent need for a child.
Chronic granulocytic leukemia usually passes through gestation to full-term delivery, unless the disease is advanced or a large spleen is present, thus allowing for continued pregnancy.