Work

Treatment of primary mediastinal B-cell lymphoma with dose-adjusted REPOCH during pregnancy

Year: 2022

Type: article

Abstract: Cancer during pregnancy is uncommon, occurring in ~1 per 1000 pregnancies annually.Lymphoma is the fourth most common malignancy associated with pregnancy, after melanoma, breast cancer, and cervical cancer. 1 Non-Hodgkin lymphoma diagnosed during pregnancy usually tends to be of a more aggressive subtype. 2 The management of primary mediastinal B-cell lymphoma (PMBCL) includes DA-REPOCH (dose-adjusted rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), which demonstrated superior outcomes (5-year overall survival rate was 97%) in the single arm phase 2 study from the national cancer institute obviating the need for radiation therapy (XRT).3 Alternatively, R-CHOP alone or with consolidation XRT is also used for the management of PMBCL, although the latter is preferred given the survival benefit associated with the XRT consolidation, 4 pending the results of phase 3 randomized study looking into the role of consolidation XRT (NCT01599559) following rituximab-containing chemotherapy regimens.The treatment of lymphoma during pregnancy can be challenging.Caring for a pregnant patient with a malignancy requires striking the difficult balance between treating the mother and, at the same time, minimizing possible harm to the fetus.5,6 Antenatal treatment is largely based on case reports and small case series.A multicenter analysis of treatment outcomes for pregnant patients with Non-Hodgkin lymphoma only included 1 patient treated with DA-REPOCH.7 There are reports of patients with PMBCL treated with R-CHOP during pregnancy and then transitioning to DA-REPOCH post partum.8 This was done due to the concern that etoposide would cause fetal cranial abnormalities and skeletal malformations.However, etoposide exposure during the second and third trimesters did not seem to cause any congenital malformations.[9][10][11][12] Some have suggested withholding rituximab during pregnancy due to its lymphodepleting effect and increased risk of fetal infection.13,14 Herein, we report a case series describing the efficacy and safety of DA-REPOCH administered to 4 antepartum women with PMBCL.This is a single-institution retrospective study that included adult pregnant patients treated with DA-REPOCH chemotherapy from 2010 to 2022.The study was approved by the Institutional Review Board and was performed per the Declaration of Helsinki.We identified 4 patients with PMBCL who received DA-REPOCH during pregnancy through a review of medical records.Information regarding the delivery and any neonatal complications was obtained by reviewing the mothers' charts.Key patient and infant characteristics are listed in Table 1.All patients received chemotherapy (all cycles) as inpatients, except patient 3, who received only the first cycle (C1) as an inpatient and the rest as an outpatient.

Source: Blood Advances

DOI: 10.1182/bloodadvances.2022008621