Lymphoproliferative diseases during pregnancy. Long-term outcomes for mother and child

Vollständiger Abstract

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Lymphoproliferative diseases are the third most common type of malignant neoplasms detected in pregnant patients. The high effectiveness of the therapy of such patients makes it relevant to study the long-term results of their treatment, as well as the health status of their children. Objective. To present the features of the course of pregnancy and its outcomes in patients with an identified lymphoproliferative disease during pregnancy, to evaluate the long-term effects of the treatment, as well as to analyze the physical development of children born to mothers with lymphoma, at birth and in the catamnesis. Materials and methods. From 2009 to 2025, 44 patients with a diagnosis of lymphoproliferative disease during pregnancy were treated at the Federal State Budgetary Institution “NMRC of Hematology” of the Ministry of Health of the Russian Federation. 28 (64%) pregnant women were diagnosed with non-Hodgkin’s lymphoma, 16 (36%) with Hodgkin’s lymphoma. Among 44 patients, 36 (82%) underwent chemotherapy during pregnancy, in 8 (18%), treatment was postponed until delivery. The median age of the patients at the time of the disease detection was 30 (range 20-39) years. In this retrospective single-center cohort study, we analyzed the development of 46 children born to 44 patients with detected lymphoma during gestation. Results. 43 (98%) of the 44 patients have been alive and are in remission of the disease with a median observation of 56 (range 2-186) months. 30 (68%) patients achieved complete remission after the first line of therapy. The remaining 14 (32%) patients required a second and subsequent line of treatment due to failure of the initial therapy. 6 (14%) cases of disease progression were registered during chemotherapy. Early relapses (1 year) — in 1 (2%) case. One patient died in the late postpartum period from septic complications after high-dose chemotherapy due to the progression of the disease. The median gestational age of newborns was 36 (range 26-40) weeks, 27 of 46 children (61%) were born prematurely. 22 newborns (49%) required follow-up in the intensive care unit. Congenital malformations of the cardiovascular system were detected in 2 babies (4%): 1 case (2%) of an open ductus arteriosus and 1 case (2%) of an interventricular septal defect. However, none of the identified pathological conditions required surgical intervention. At the time of the study, the median age of the children was 5.0 (range 0.3—15.3) years. The following LEN organs diseases were diagnosed later for 11 months among 46 children : adenoid hypertrophy — n=4 (9%), tonsillitis — n= 1 (2%), laryngitis — n=3 (7%), otitis media — n=3 (7%). One child (2%), whose mother did not receive chemotherapy during pregnancy, was diagnosed with cerebral palsy in the first year of life. Conclusion. Despite the diagnostic and therapeutic difficulties in verifying lymphoproliferative diseases during pregnancy, as well as the high frequency of premature birth, long-term catamnesis observations demonstrate favorable outcomes. The patients have long-term remissions, and the condition of their children is satisfactory in most cases.