Treatment of Burkitt's lymphoma during pregnancy

Abstract

Objective: To report a case of both successful maternal treatment outcome and normal fetal outcome in a patient who was diagnosed with Burkitt's lymphoma (BL) and aggressively treated with 6 different chemotherapy agents during the second and third trimesters of pregnancy.

Case summary: A 21-year-old white woman was diagnosed with stage II BL of the head and neck at 26 weeks' gestation. She was treated with 2 cycles of systemic intensive polychemotherapy, including cyclophosphamide, vincristine, doxorubicin, cytarabine, etoposide, ifosfamide, mesna, and intrathecal cytarabine with growth factor support during the second and third trimesters. She delivered a healthy, premature boy 6 weeks after diagnosis. At a follow-up 1 year after diagnosis, the patient remained disease-free and the baby remained healthy.

Discussion: The prognosis of BL depends on the stage at diagnosis, as well as treatment aggressiveness. Previous reports indicate that most patients diagnosed with BL during pregnancy received either no treatment or only one chemotherapy agent, and the majority ultimately died of rapidly progressive diseases. The fetal outcomes seem to depend primarily on the time of exposure to chemotherapy and/or radiation, doses, specific chemotherapy agent given, and frequency of treatment during pregnancy. Limited retrospective data suggest that chemotherapy given after the first trimester is relatively safe and does not adversely affect the short- and long-term fetal outcomes.

Conclusions: Treatment of BL during pregnancy can be very challenging because an aggressive approach is the main key to maximize the patient's long-term disease-free survival. However, the health of the unborn child should also be a concern when choosing treatment. This case demonstrates that combination chemotherapy given after the first trimester did not result in any congenital malformations or acute adverse effects in the fetus. Long-term follow-up of the child remains necessary to evaluate possible long-term complications.