Management of classical Hodgkin lymphoma during pregnancy
- Joachim Yahalom, MD
Joachim Yahalom, MD
- Member and Professor of Radiation Oncology
- Memorial Sloan-Kettering Cancer Center
- Cornell University Weill College of Medicine
- Steven Horwitz, MD
Steven Horwitz, MD
- Associate Attending
- Memorial Sloan-Kettering Cancer Center
- Section Editors
- Arnold S Freedman, MD
Arnold S Freedman, MD
- Section Editor — Lymphoproliferative Disorders
- Professor of Medicine
- Harvard Medical School
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Although Hodgkin lymphoma (formerly called Hodgkin's disease, HL) accounts for only 10 percent of all lymphomas, it is one of the most common lymphoma subtypes diagnosed during pregnancy, largely because the peak incidence of HL coincides with female reproductive age. However, the association between HL and pregnancy is uncommon. HL is diagnosed in approximately 1:1000 to 1:6000 pregnancies and accounts for 3 percent or fewer of all patients with HL [1-3]. (See "Epidemiology, pathologic features, and diagnosis of classical Hodgkin lymphoma", section on 'Epidemiology'.)
As a result, there are few large series that have evaluated the many issues that must be addressed in such women. This topic will review the clinical presentation and management of HL during pregnancy, the interaction of malignancy and pregnancy, and the effects of treatment on the developing fetus and delivered infant. The diagnosis and management of HL in the nonpregnant adult is discussed separately. (See "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults" and "Overview of the treatment of classical Hodgkin lymphoma in adults".)
Pregnant patients with HL present in a similar fashion to nonpregnant patients with HL (eg, painless lymphadenopathy). Of importance, some signs and symptoms due to the HL (eg, fatigue, shortness of breath, anemia, thrombocytopenia) overlap with common signs and symptoms seen during pregnancy, potentially resulting in a delay of diagnosis. (See "Thrombocytopenia in pregnancy" and "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults", section on 'Clinical presentation'.)
Retrospective case series have described the clinical presentation of pregnant women with HL, with generally similar findings [1,3-6]. One of the larger series consisted of 48 women (median age 26 years) with 50 pregnancies occurring during active HL . The diagnosis of HL was made in 12 patients before conception, in 10 during pregnancy, and in 27 within nine months after delivery or pregnancy termination. Each pregnant woman was matched with three nonpregnant HL controls. The stage at diagnosis did not differ significantly from the controls: stage I, 25 percent; stage II, 46 percent; stage III, 17 percent; and stage IV, 12 percent (table 1). (See "Initial evaluation and diagnosis of classical Hodgkin lymphoma in adults", section on 'Clinical presentation'.)
The presence of B symptoms (ie, fever, night sweats, or weight loss exceeding 10 percent of body weight) is variable. While most patients from North American series have presented without B symptoms [1,4,5,7], one report from Mexico described B symptoms in 10 of 14 patients . (See "Staging and prognosis of Hodgkin lymphoma", section on 'Criteria for B symptoms'.)
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- CLINICAL PRESENTATION
- STAGING DURING PREGNANCY
- EFFECTS OF TREATMENT DURING PREGNANCY ON FETAL GROWTH AND DEVELOPMENT
- First trimester
- Second and third trimesters
- Long-term outcome
- MANAGEMENT OF HL DURING PREGNANCY
- Selection of patients for deferred therapy
- - Specific regimens
- - Antiemetics
- - Effect of pregnancy on drug pharmacokinetics
- Radiation therapy
- Elective termination of pregnancy
- DELIVERY OF THE INFANT
- MANAGEMENT AFTER DELIVERY
- INFLUENCE OF PREGNANCY ON THE COURSE OF HL