Case Report: Low-dose AML therapy with the Brazilian pediatric GELMAI protocol as a bridge strategy during a high-risk pregnancy complicated by severe infection: sustained maternal remission and survival with favorable early developmental follow-up
Year: 2026
Type: article
Abstract: Acute myeloid leukemia (AML) during pregnancy is rare and requires urgent maternal treatment while fetal toxicity and prematurity must also be considered. We report a 17-year-old adolescent diagnosed with AML at 21 weeks and 6 days of gestation, based on first-trimester ultrasonographic dating, after presenting with severe pancytopenia, pneumonia, COVID-19, and septic shock. Bone marrow evaluation showed 73.3% blasts, with an immature myeloid immunophenotype; conventional cytogenetics showed 46,XX[20]. Available molecular testing was negative for CBFB::MYH11, FLT3-ITD, and NPM1, but broader molecular profiling was not available. Based on the studies available, the leukemia was most consistent with AML defined by differentiation under WHO 2022 and AML, not otherwise specified under ICC 2022, while acknowledging that incomplete molecular testing precluded definitive exclusion of genetically defined AML entities. After multidisciplinary counseling, the patient chose to continue the pregnancy. Because of recent septic shock, ongoing pregnancy, and concern for toxicity from intensive induction, treatment was initiated with the low-dose MAG regimen used in the Brazilian pediatric GELMAI protocol (mitoxantrone, low-dose cytarabine, and G-CSF). After MAG I, bone marrow evaluation showed no morphologic evidence of residual leukemia and no measurable leukemic population by multiparameter flow cytometry at the reported assay sensitivity; subsequent peripheral blood count recovery was documented, consistent with complete remission (CR). Cesarean delivery was required at 28 weeks and 5 days of gestation because of fetal growth restriction. The patient subsequently completed protocol-directed therapy and remained without evidence of relapse at last follow-up. The child survived very preterm birth and, at follow-up in April 2026, had growth parameters near the 50th percentile, age-appropriate neurodevelopment, a normal complete blood count, and a normal echocardiogram. This case illustrates a carefully selected, non-standard low-dose bridge strategy when immediate intensive induction was considered particularly hazardous; it does not establish generalizable efficacy or long-term fetal safety.
Source: Frontiers in Medicine
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7225639209