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CASE REPORT
Year : 2015  |  Volume : 40  |  Issue : 4  |  Page : 201-202

Rituximab-containing chemotherapy in pregnancy with malignancy


1 Department of Hematology, NRS Medical College and Hospital, Kolkata, West Bengal, India
2 Department of Gynaecology, Midnapore Medical College, Midnapore, West Bengal, India

Date of Submission11-Dec-2015
Date of Acceptance14-Jul-2015
Date of Web Publication23-Nov-2015

Correspondence Address:
Tuphan K Dolai
Department of Hematology, NRS Medical College and Hospital, 138, AJC Bose Road, Kolkata 700014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1067.170222

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  Abstract 

Non-Hodgkin lymphoma diagnosed during pregnancy often has an aggressive histology, with diffuse large B-cell or peripheral T-cell lymphomas being most common in this context. Aggressive lymphomas during pregnancy present a difficult challenge in diagnosis, especially in staging by means of radiological evaluation. The aim of the treatment is to give the mother the best chance for cure but at the same time with minimal harm to the fetus. Most cytotoxic agents, including rituximab, cross the human placenta and reach the fetus. Rituximab-based chemotherapy (R-CHOP) is now considered the standard of care and generally considered safe for the treatment of aggressive lymphomas during pregnancy except during the first trimester.

Keywords: non-Hodgkin lymphoma, pregnancy, rituximab


How to cite this article:
Mandal PK, Dolai TK, Bose S, Bhattacharyya M. Rituximab-containing chemotherapy in pregnancy with malignancy. Egypt J Haematol 2015;40:201-2

How to cite this URL:
Mandal PK, Dolai TK, Bose S, Bhattacharyya M. Rituximab-containing chemotherapy in pregnancy with malignancy. Egypt J Haematol [serial online] 2015 [cited 2019 Dec 11];40:201-2. Available from: http://www.ehj.eg.net/text.asp?2015/40/4/201/170222


  Introduction Top


Lymphoma is the fourth most frequent malignancy diagnosed during pregnancy after breast, cervix, and ovarian cancers, occurring in ~1 : 6000 deliveries [1] . The incidence of non-Hodgkin lymphoma (NHL) during pregnancy is rare; fewer than 100 cases have been reported [2] . We report a case of pregnancy with NHL treated with rituximab (chimeric anti-CD20 monoclonal B-cell-depleting antibody) containing regimen with successful outcome.


  Case report Top


A 32-year-old second gravida at 20 weeks of gestational age presented with fatigability, weakness, low back pain and generalized lymphadenopathy of 2-month duration. There was no history of fever and weight loss. Examination revealed anaemia and generalized lymphadenopathy without any organomegaly.

Haemogram and ferokinetics were normal. Serum chemistries were normal, except for slightly elevated lactate dehydrogenase (402 U/l) and serum β2 -microglobulin (2553.2 μg/l). HBsAg, anti-HCV and anti-HIV-I and II were nonreactive. Chest radiograph with abdominal shield did not show any lymphadenopathy or parenchymal lesion. MRI of lumbosacral spine and pelvis showed altered signal density lesion in the lumbar vertebral body and sacrum ([Figure 1]a and b). Cervical lymph node biopsy with histopathology ([Figure 2]) revealed NHL-diffuse large cell type. Tumour cells expressed CD20, PAX-5 and CD30 and were negative for CD3, Alk-1, CD15 and cytokeratins. Bone marrow biopsy was normal. Ultrasonography for fetoplacental profile revealed single live fetus in unstable lie with a maturity of 20 ± 2 weeks.
Figure 1 (a, b) MRI of lumbosacral spine showing altered signal density lesion in the lumbar vertebrae.

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Figure 2 Cervical lymph node histopathology revealed non-Hodgkin lymphoma (NHL)-diffuse large cell type (inset: ×40 magnification).

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The patient was diagnosed with NHL-diffuse large B-cell lymphoma (DLBCL), stage-IVA, international prognostic factor index score 2 (low intermediate risk) with 20 weeks of gestation.

After counseling, chemotherapy with R-CHOP (rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone) in a 21-day cycle was started. The fetus was monitored by means of periodic ultrasonography for growth and congenital anomalies. The patient underwent elective caesarean section at 37 weeks of gestation on day 21 after fifth cycle. Sixth cycle of chemotherapy was deferred and completed after delivery. The newborn was screened for haematological parameters, infection and physical anomalies and was found to be normal. Chemotherapy was uneventful except for one episode of respiratory tract infection after the second cycle. PET-CT after 6 weeks of completion of therapy did not show any residual disease.


  Discussion Top


Incidence of pregnancy-associated NHL is quite low, but often has an aggressive histology, with diffuse large B-cell or peripheral T-cell lymphomas being most common [2] .

Data suggest that CHOP chemotherapy can be administered safely during the second and third trimesters without adverse fetal outcomes [3] .

Of all known reports (21 cases) of rituximab administered during an established pregnancy for life-threatening illnesses, six were exposed to multiagent chemotherapy in addition to rituximab for lymphoma. All pregnancies, except for one resulted in live births. The majority of infants were born full term. No maternal deaths, neonatal deaths or congenital malformations were reported [4] .

Because of scarcity of data (six cases), we report this case and concluded that pregnancy with NHL (DLBCL) can be managed safely and effectively with rituximab-containing chemotherapy (R-CHOP).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Pentheroudakis G, Pavlidis N. Cancer and pregnancy: poena magna, not any-more. Eur J Cancer 2006; 42 :126-140.  Back to cited text no. 1
    
2.
Lishner M, Zemlickis D, Sutcliffe SB, et al. Non-Hodgkin′s lymphoma and pregnancy. Leuk Lymphoma 1994; 14 :411-413.  Back to cited text no. 2
    
3.
Aviles A, Neri N, Nambo MJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol 2006; 17 :286-288.  Back to cited text no. 3
    
4.
Chakravarty EF, Murray ER, Kelman A, et al. Pregnancy outcomes after maternal exposure to rituximab. Blood 2011; 117:1499-1506.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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