Contributions
Abstract: PB1647
Type: Publication Only
Background
The frequency of cancer and pregnancy is relatively rare, occurring in about one in 1000 pregnancies.
The most common tumors diagnosed during pregnancy are cervical and breast cancer followed by melanoma, leukemia and lymphoma. The conducting of a pregnant patient with malignancy is very challenging and requires a multidisciplinary approach.
Aims
Here, we present a case of acute lymphoblastic leukemia in pregnancy.
Methods
A 29-year-old female at 28 weeks gestation presented to the emergency department with a 7-day history of fatigue, fever, bruising along with nose and gum bleeding. Laboratory investigation revealed a white blood cell count of 77.3 × 103/mm3, hemoglobin 3.8 (g/dl) and platelets 10 × 103/µl.
Results
A bone marrow biopsy revealed precursor B-cell ALL, 93% blasts with BCR-ABL rearrangement (Philadelphia chromosome) by fluorescent in situ hybridization (FISH) in 81% of cells and reverse transcriptase-polymerase chain reaction (RT-PCR) detecting BCR-ABL breakpoint fusion. Cytogenetics showed 46,XX,t(9;22)(q34;q11.2) and immunohistochemistry revealed the following: moderately positive for CD10, CD19, CD22, CD34, CD45, HLA-DR and cytoplasmic Tdt while negative for CD3, CD5, CD11b, CD15, CD20, CD33, CD38, CD56, CD71, CD117, kappa and lambda light chain surface antigen. Ultrasound revealed a single living fetus at 28 weeks with weight corresponding to the 39th percentile and normal amniotic fluid. The solution was made to wait until 30 weeks to deliver the baby via Caesarean section due to an operative risk of hemorrhage and sepsis to the mother if delivered while pancytopenic and to give more time for fetal maturity. The patient was started on intravenous HyperCVAD without any dose reduction. At 30 weeks gestation ( 2 weeks after initiation of induction therapy), a Caesarean section was performed with the delivery of a baby girl with a weight of 1346 grams corresponding to the 26th to 50th percentile for the gestational age. The baby required transient respiratory assistance for 10 hours post delivery due to cyanosis and poor respiratory effort.
On postpartum day 11 the mother was started on HyperCVAD combination chemotherapy and dasatinib at 50 mg twice a day for 14 days given with each cycle of chemotherapy. She was also given prophylactic intrathecal chemotherapy. Cerebrospinal fluid analysis done after delivery was negative for central nervous system implication. A bone marrow biopsy accomplished after completion of cycle one of high-dose cytarabine and methotrexate revealed normal cytogenetic. BCR-ABL was negative by FISH and PCR detected 0.005% residual BCR-ABL. No blasts in bone marrow biopsy were found and flow cytometry was negative. Currently she is awaiting allogenic bone marrow transplant. The baby continues to do well and has reached normal developmental milestones at 18 months of age.
Conclusion
Our case represents the feasibility of treating ALL with HyperCVAD during the third trimester of pregnancy with favorable outcomes.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, chemotherapy, Pregnancy
Abstract: PB1647
Type: Publication Only
Background
The frequency of cancer and pregnancy is relatively rare, occurring in about one in 1000 pregnancies.
The most common tumors diagnosed during pregnancy are cervical and breast cancer followed by melanoma, leukemia and lymphoma. The conducting of a pregnant patient with malignancy is very challenging and requires a multidisciplinary approach.
Aims
Here, we present a case of acute lymphoblastic leukemia in pregnancy.
Methods
A 29-year-old female at 28 weeks gestation presented to the emergency department with a 7-day history of fatigue, fever, bruising along with nose and gum bleeding. Laboratory investigation revealed a white blood cell count of 77.3 × 103/mm3, hemoglobin 3.8 (g/dl) and platelets 10 × 103/µl.
Results
A bone marrow biopsy revealed precursor B-cell ALL, 93% blasts with BCR-ABL rearrangement (Philadelphia chromosome) by fluorescent in situ hybridization (FISH) in 81% of cells and reverse transcriptase-polymerase chain reaction (RT-PCR) detecting BCR-ABL breakpoint fusion. Cytogenetics showed 46,XX,t(9;22)(q34;q11.2) and immunohistochemistry revealed the following: moderately positive for CD10, CD19, CD22, CD34, CD45, HLA-DR and cytoplasmic Tdt while negative for CD3, CD5, CD11b, CD15, CD20, CD33, CD38, CD56, CD71, CD117, kappa and lambda light chain surface antigen. Ultrasound revealed a single living fetus at 28 weeks with weight corresponding to the 39th percentile and normal amniotic fluid. The solution was made to wait until 30 weeks to deliver the baby via Caesarean section due to an operative risk of hemorrhage and sepsis to the mother if delivered while pancytopenic and to give more time for fetal maturity. The patient was started on intravenous HyperCVAD without any dose reduction. At 30 weeks gestation ( 2 weeks after initiation of induction therapy), a Caesarean section was performed with the delivery of a baby girl with a weight of 1346 grams corresponding to the 26th to 50th percentile for the gestational age. The baby required transient respiratory assistance for 10 hours post delivery due to cyanosis and poor respiratory effort.
On postpartum day 11 the mother was started on HyperCVAD combination chemotherapy and dasatinib at 50 mg twice a day for 14 days given with each cycle of chemotherapy. She was also given prophylactic intrathecal chemotherapy. Cerebrospinal fluid analysis done after delivery was negative for central nervous system implication. A bone marrow biopsy accomplished after completion of cycle one of high-dose cytarabine and methotrexate revealed normal cytogenetic. BCR-ABL was negative by FISH and PCR detected 0.005% residual BCR-ABL. No blasts in bone marrow biopsy were found and flow cytometry was negative. Currently she is awaiting allogenic bone marrow transplant. The baby continues to do well and has reached normal developmental milestones at 18 months of age.
Conclusion
Our case represents the feasibility of treating ALL with HyperCVAD during the third trimester of pregnancy with favorable outcomes.
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia, chemotherapy, Pregnancy