By Lynda Williams, medwireNews Reporter
medwireNews: Women who are diagnosed with haematological malignancies during pregnancy have similar overall survival (OS) to peers diagnosed within a year of their pregnancy ending, indicates research published in The Lancet Haematology.
“This information is both important and reassuring for women and their families”, say Pierre Pinson (Cochin Hospital, Paris, France) and co-investigators.
Nevertheless, the team found that women diagnosed with haematological malignancy during their pregnancy are significantly more likely to experience severe maternal morbidity and obstetric complications than women without any haematological malignancy.
“It is therefore critical that these women receive care in highly specialized centres that are equipped with the necessary human and technical resources to manage both haematological and maternal complications”, the authors say.
The team reviewed data for 9,996,523 pregnancies in 5,995,235 women registered with the French National Healthcare Data System between January 2012 and December 2022. Of these, 1366 were affected by haematological malignancies, including 413 that occurred during pregnancy and 953 within 12 months of the end of pregnancy, the team says.
The most common haematological malignancies diagnosed during pregnancy were Hodgkin’s lymphoma (39.5%), acute leukaemia (21.6%), aggressive B-cell non-Hodgkin’s lymphoma (11.6%), myeloproliferative neoplasm (8.7%), and myelodysplastic syndrome or chronic myelomonocytic leukaemia (5.1%).
Median age at diagnosis was 30.0 years and the median gestational age was 25.0 weeks, with 20.3% of malignancies diagnosed during the first trimester and 33.7% and 46.0% in the second and third trimesters, respectively. Almost a fifth (19.4%) of pregnancies were terminated after the haematological malignancy diagnosis and five women experienced miscarriage unrelated to chemotherapy exposure.
Women with haematological malignancy diagnoses during and within a year of pregnancy were followed-up for a median of 6.7 and 5.9 years after diagnosis, respectively. The 5-year OS survival rates for these two groups were 91.2% and 90.3%, respectively, with no significant difference detected after inverse probability weighting (IPW, adjusted hazard ratio [HR]=0.91).
Nor was there any significant difference in the OS among women diagnosed during or after pregnancy by their specific diagnoses, such as Hodgkin’s lymphoma (95.8 vs 91.8%, HR=0.56).
There were no deaths during pregnancy or delivery among women with a haematological malignancy diagnosis. However, there was a significantly higher rate of pregnancy-associated death from any cause within a year post-pregnancy compared with a reference group of 7,945,909 women who completed pregnancy without a diagnosis of any haematological malignancy, at 29.06 versus 0.21 deaths per 1000 pregnancies and an IPW-adjusted odds ratio (OR) of 133.34.
Similarly, maternal morbidity in the 328 women who were diagnosed during pregnancy and completed their pregnancy was “notably higher” compared with the reference group, the researchers say, with women more likely to experience complications such as pre-eclampsia (4.3 vs 2.1%), thrombosis (1.8 vs 0.2%) and infection (12.8 vs 8.1%).
Moreover, severe maternal morbidity was significantly more common in the women diagnosed during pregnancy, affecting 26.2% compared with just 1.5% of the reference group, giving an OR of 22.71. This included blood product transfusion (17.7 vs 0.4%), sepsis (6.4 vs 0.5%) and disseminated intravascular coagulation (3.1 vs 0.2%).
Women with a diagnosis of haematological malignancy within 12 months of the end of their pregnancy were also at significantly increased risk of severe maternal morbidity versus the reference group, affecting 5.3% of 760 completed pregnancies, the authors report.
In addition, women with a haematological malignancy diagnosis during pregnancy were significantly more likely than those without to give birth before 32 weeks’ gestation (9.8 vs 1.2%, OR=11.90) or between 32 and 36 weeks’ gestation (35.4 vs 5.4%, OR=11.76). This was also true for women diagnosed within a year of completing pregnancy (OR=1.79 and 1.54, respectively).
Analysis of chemotherapy use in women with Hodgkin’s lymphoma, acute leukaemia and aggressive B-cell non-Hodgkin’s lymphoma showed that treatment for these conditions began an average 7.1, 2.1 and 2.8 weeks after diagnosis, respectively, most commonly in the second trimester.
Among women who were diagnosed during pregnancy and received chemotherapy, treatment during pregnancy was associated with significantly poorer OS than treatment after pregnancy (IPW-adjusted HR=3.91). Severe maternal morbidity was also significantly more common with chemotherapy during pregnancy (34.1 vs 20.0, IPW-adjusted OR=3.22), as was birth before 32 weeks’ gestation (14.6 vs 4.5%, OR=2.99).
Pinson et al say: “[O]ur understanding of the underlying pathophysiological mechanisms, progression-free survival after treatment, the effect of chemotherapy on pregnancy, and the neonatal and infant consequences of haematological malignancies during pregnancy is limited and warrants further investigation.”
They conclude that “international efforts” on research in this area “would ensure access to multidisciplinary centres with expertise in these rare and specific situations.”
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Lancet Haematol 2024; doi:10.1016/S2352-3026(24)00288-6