Introduction

The diagnosis of a hematological malignancy during pregnancy poses a major challenge to the pregnant woman, her family, and the medical team. Treatment of a pregnant woman with chemotherapy poses a risk to the fetus and raises therapeutic, ethical, and social dilemmas. A woman diagnosed with a hematological malignancy during pregnancy should be managed jointly by a multidisciplinary team comprising consultant hematologist, obstetrician, midwife, anesthesiologist, and neonatologist. Consideration should be given to the health of both mother and baby, with the informed wishes of the mother being considered paramount by the medical team. Psychological support should be offered to the woman and her family. Information giving should be supported by written information and a treatment plan. The woman should be fully informed about the diagnosis, her treatment options, potential complications, and the possible fetal and maternal outcomes.

Hematological malignancies can be broadly divided into myeloid and lymphoid tumors, according to the presumed cell of origin for each disorder. The incidences of myeloid and lymphoid hematological malignancies in the general population and summaries of the standard therapeutic approaches in the nonpregnant population are summarized in Tables 36.1 and 36.2.

• The myeloid tumors that will be considered in this chapter include:

• The lymphoid tumors to be considered include:

Acute lymphoblastic leukemia (ALL), though technically a lymphoid tumor, is considered with AML because of commonalities in the approach to treatment.

Myeloid Tumors

Acute Leukemia

Acute leukemia diagnosed during pregnancy is uncommon, occurring in approximately 1 in 75,000– 100,000 pregnancies. AML represents approximately two-thirds and ALL one-third of cases.

The diagnosis of leukemia in pregnancy is more challenging than in nonpregnant individuals, since anemia and thrombocytopenia, which are common presenting features of acute leukemia, are common findings in pregnancy.