Multidisciplinary care found key to managing blood cancers during pregnancy
Evidence-based guidelines stress the importance of timely diagnosis, collaborative care, and maternal-infant safety in addressing the rising incidence of hematological malignancies in pregnancy.
Multidisciplinary care found key to managing blood cancers during pregnancy | Image Credit: © WavebreakMediaMicro - © WavebreakMediaMicro - stock.adobe.com.
Evidence-based, multidisciplinary care is vital for the management of blood cancers in pregnancy, according to recent guidelines published in The Lancet.1
The incidence of blood cancers such as acute leukemia and aggressive lymphomas has increased over time, with a current prevalence of 12.5 cases per 100,000 pregnancies. The incidence rose by 2.7% per year from 1994 to 2013.1
“But on top of this, women can experience treatment delays, inaccurate information and communication breakdowns, all of which increases the worry associated with a cancer diagnosis and fears for their unborn baby,” said lead investigator Georgia Mills, MBBS, FRACP, FRCPA, from Macquarie Medical School.1
The rise in blood cancer cases has been linked to women having children later, improved diagnostic techniques, and increased health system engagement. According to investigators, “a multidisciplinary approach to the management of hematological malignancies in pregnancy is paramount.”2
Despite this need, researchers noted the lack of guidelines to manage these malignancies in pregnancy and developed a guideline to address this gap. The viewpoint was developed by the Hematology in Obstetrics and Women’s Health Collaborative.2
Searches of the MEDLINE, PubMed, Embase, and Scopus databases were performed. Following reviews, the councils of the Society of Obstetric Medicine of Australia and New Zealand endorsed the guidelines, alongside other health groups.2
Researchers noted the challenges of diagnosing hematological malignancies in pregnancy, including changes in weight and appetite, fatigue, night sweats, pruritus, and pain. These symptoms may be linked to physiological changes in pregnancy rather than hematological malignancies.2
With these challenges in mind, investigators recommended timely histopathological diagnosis through bone marrow aspirate and trephine or lymph node biopsy. They also noted the safety of local anesthetic and methoxyflurane for use in all stages of pregnancy.2
The guidelines detailed the importance of consistent, multidisciplinary communication across teams. This includes early referral to specialized centers experienced in managing cancer in pregnant patients, as recommended by the Cancer Institute of New South Wales and the European Society of Medical Oncology.2
Considerations for management during pregnancy include parental wishes, physiological changes in pregnancy, and natural history of the malignancy. Additionally, the guidelines recommended women be able to access nursing and midwifery specialists and a comprehensive counseling service.2
An increase in chemotherapy use in pregnancy has also been reported within the past 25 years. At the same time, decreases in pregnancy termination, spontaneous miscarriage, preterm labor, and stillbirth rates have been observed. However, investigators noted a lack of data about pregnancy termination in pregnant patients with hematological malignancies.2
Week 2 to 8 of gestation were noted as the period when infants are most vulnerable to drug-related structural birth defects. Chemotherapy use during the first trimester may lead to miscarriage, intrauterinefetalgrowthrestriction, fetal malformation, and fetal death.2
Despite these risks, investigators highlighted the safety of immunochemotherapy for use outside the first trimester. They stated that regardless the difficulty ascertaining safety, timely treatment during pregnancy is vital for maternal and infant health.2
“In providing optimal care, close communication, shared decision making, and maintaining focus on the goals of a successful pregnancy outcome and a complication-free survival are necessary,” investigators wrote.“Evidence-based and empathic multidisciplinary care is crucial to achieve these aims.”2
References
- New guidelines for managing blood cancers in pregnancy. Macquarie University. January 3, 2025. Accessed January 10, 2025. https://www.eurekalert.org/news-releases/1068637
- Mills G, Shand A, Kennedy D, et al. Position statement on the diagnosis and management of acute leukaemia and aggressive lymphomas in pregnancy. The Lancet. 2025. doi:10.1016/S2352-3026(24)00309-0
S4E1: New RNA platform can predict pregnancy complications
February 11th 2022In this episode of Pap Talk, Contemporary OB/GYN® sat down with Maneesh Jain, CEO of Mirvie, and Michal Elovitz, MD, chief medical advisor at Mirvie, a new RNA platform that is able to predict pregnancy complications by revealing the biology of each pregnancy. They discussed recently published data regarding the platform's ability to predict preeclampsia and preterm birth.
Listen
High opioid use disorder and severe maternal morbidity rates reported among Medicaid patients
January 8th 2025Pregnant patients with opioid use disorder enrolled in Medicaid face significantly increased risks of severe maternal morbidity, underscoring the need for targeted state Medicaid interventions.
Read More
