New guidelines show better outcomes for managing hematological malignancies in pregnancy

In a recent interview with Contemporary OB/GYN, Giselle Kitson-Gerber, MD, a hematologist with expertise in obstetric hematology, shared insights into new guidelines for managing hematological malignancies during pregnancy, specifically acute leukemia and aggressive lymphomas.

These conditions pose significant risks to maternal and fetal health, but advancements in management provide hope for better outcomes. Acute leukemia is life-threatening if untreated, with symptoms such as anemia, infection, and bleeding, although it is often detected through routine blood work during pregnancy. Aggressive lymphomas, on the other hand, may present with masses in the neck, chest, or abdomen, often identified through obstetric ultrasounds, or symptoms such as shortness of breath, fevers, or night sweats.

The guidelines emphasize the importance of delaying birth to optimize fetal neurocognitive development. Evidence shows that gestational age at delivery has a greater impact on long-term outcomes than in utero exposure to chemotherapy. Women diagnosed in the second or early third trimester are encouraged to undergo chemotherapy during pregnancy rather than opting for early delivery. PET scans, critical for diagnosing and monitoring lymphomas, are now considered safe during pregnancy when proper modeling of fetal radiation exposure is conducted. The guidelines also address breastfeeding and include data on the limited use of newer treatment agents during pregnancy.

A multidisciplinary approach is essential for managing these complex cases. Collaboration among maternal-fetal medicine specialists, obstetricians, hematologists, midwives, nurses, and allied health professionals ensures comprehensive care. Effective communication, seamless coordination, and detailed documentation are critical, especially in settings where hospital services may be physically separated. The guidelines stress the importance of creating a written management plan covering all trimesters, delivery, and postpartum care to guide both patients and health care teams.

The key clinical takeaways focus on avoiding premature decisions such as early termination or delivery, involving a multidisciplinary team, and reassuring patients that positive outcomes are achievable. Kitson-Gerber highlighted that most women with hematological malignancies can be treated effectively during pregnancy and encouraged health care providers to consult the guidelines for evidence-based strategies. With expert support and collaborative care, health care teams can help ensure favorable outcomes for both mother and child in these high-risk scenarios.