Chemotherapy for Hodgkin Lymphoma During Pregnancy May Be Safe

A study published in The Lancet Haematology found that maternal survival was not impacted when pregnant women with Hodgkin lymphoma (HL) received antenatal chemotherapy during pregnancy. The researchers noted that this suggests “that antenatal chemotherapy or deferral of treatment until postpartum in selected patients can be considered, with regular obstetric follow-up to safeguard fetal growth.”

The multicenter, retrospective cohort study included oncological and obstetric data from 134 pregnant patients who were diagnosed with HL between January 1, 1969, and August 1, 2018. Researchers used the International Network on Cancer, Infertility and Pregnancy database to obtain data from 17 academic centers in Belgium, Czech Republic, Denmark, Greece, Israel, Italy, Mexico, the Netherlands, Russia, the United Kingdom, and the United States.

They assessed patient management during three time periods: earlier than 1995, 1995 to 2004, and 2005 to 2018. Data were compared for pregnant women who received or did not receive antenatal chemotherapy and the following factors were considered: birthweight, obstetric or neonatal complications, and admission to a neonatal intensive care unit (NICU).

About half of patients (n=72; 54%) initiated antenatal chemotherapy, while 56 (42%) did not receive treatment during pregnancy, and six (4%) received only radiotherapy. With each time period considered, chemotherapy was increasingly initiated during pregnancy.

Fetal and maternal outcomes related to chemotherapy

The incidence of neonates who were small for gestational age did not differ between chemotherapy-exposed neonates (n=15/69; 22%) and non-exposed neonates (n=6/42; 16%; P=0.455).

Admission to the NICU also did not differ (n=19; 29% versus n=12; 35%). Birthweight percentiles were lower in neonates who were exposed to chemotherapy compared with those not exposed (P=0.035).

Patients receiving antenatal therapy had more obstetric complications than those who did not receive chemotherapy (P=0.005), the most common of which were preterm contractions (n=9; 12% versus n=3; 7%) and preterm rupture of membranes (n=4; 5% versus n=0).

Researchers compared maternal survival among 77 pregnant patients and 211 non-pregnant controls. Five-year progression-free survival (PFS) for patients with early-stage HL was 82.6% (95% CI, 67.4-91.1) for 62 pregnant patients and 88.3% (95% CI, 81.6-92.7) for 142 controls (hazard ratio [HR] = 1.80; 95% CI, 0.84-3.87; P=0.130). Five-year overall survival (OS) was 97.3% (95% CI, 82.3-99.6) and 98.4% (95% CI, 93.6-99.6), respectively (HR=1.63; 95% CI, 0.35-7.65; P=0.534).

In patients with advanced-stage HL (15 pregnant patients and 69 controls), five-year PFS was 90.9% (95% CI, 50.8-98.7) versus 74.0% (95% CI, 60.9-83.3), respectively (HR=0.36; 95% CI, 0.04-2.90; P=0.334). Five-year OS was 100% and 96.2% (95% CI, 85.5-99.1), respectively (P=0.146).