Treatment for acute promyelocytic leukemia during pregnancy

Abstract


AIM: To study the experience in managing patients with acute promyelocytic leukemia (APL) diagnosed in different periods of pregnancy/MATERIAL AND METHODS: Nine women with APL were treated in 1998-2013. When APL was diagnosed in the first trimester of pregnancy, the latter was terminated (n=1); when its diagnosis was made in the second trimester, chemotherapy (CT) followed by delivery (D) was performed (n=3); when it was done in the third trimester, D followed by CT was done in relation to gestational age (n=2) or these were performed at a later gestational age (n=1). APL was treated in 5 and 1 patients according to the AIDA protocol and the 7+3 plus ATRA one, respectively/RESULTS: All the patients with APL achieved remission after the first cycle of induction CT; 5 of the 6 patients did at the moment of delivery; one patient underwent emergency delivery during cytopenia after the cycle. The gestational age at delivery after CT was 34 (34-40) weeks. Spontaneous term labor occurred in 2 patients at an obstetric hospital. Cesarean section was made in 4 of the 6 patients. All babies were born alive, healthy, and without developmental abnormalities. Their age at the time of analyzing the results was 2.5 months to 15 years. Four of the 9 patients are presently alive. Late recurrences occurred in 3 (33%) patients. The median overall survival is 26 (0.25-128) months; the median relapse-free survival is 17.5 (0-127) months/CONCLUSION: APL treatment in pregnant women, which is aimed at saving two lives, is effective and reasonable.

Full Text

Лечение острого промиелоцитарного лейкоза у беременных. - Резюме. Цель исследования. Изучить опыт ведения больных острым промиелоцитарным лейкозом (ОПЛ), диагноз которым установили на разных сроках беременности. Материалы и методы. В 1998-2013 гг. провели лечение 9 женщин с ОПЛ. При диагностике ОПЛ в I триместре беременность прерывали (n=1), во II проводили химиотерапию (ХТ) с последующим родоразрешением - РР (n=3), при диагностике в III триместре беременности (ТБ) в зависимости от сроков гестации либо выполняли РР с последующей ХТ (n=2), либо проводили ХТ и РР в более поздние сроки гестации (n=1). Лечение ОПЛ у 5 больных проводили по протоколу AIDA, у 1 больной - по программе "7+3" с ATRA. Результаты. Ремиссии ОПЛ достигли у всех больных после первого индукционного курса ХТ, у 5 из 6 больных - к моменту РР, одной больной РР выполнили по срочным показаниям в периоде цитопении после курса. Срок беременности на момент РР после ХТ составил 34 (34-40) нед. Самостоятельные срочные роды в условиях акушерского стационара произошли у 2 больных. У 4 из 6 выполняли кесарево сечение. Все дети живы, здоровы, без отклонений в развитии. Возраст детей на момент анализа результатов от 2,5 мес до 15 лет. В настоящее время живы 4 из 9 больных. Поздние рецидивы возникли у 3 (33%) больных. Медиана общей продолжительности жизни 26 (0,25-128) мес, медиана безрецидивной продолжительности жизни - 17,5 (0-127) мес. Заключение. Лечение ОПЛ у беременных, направленное на "спасение двух жизней" эффективно и оправдано.

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Copyright (c) 2013 Troitskaia V.V., Parovichnikova E.N., Sokolov A.N., Kokhno A.V., Makhinia S.A., Galstian G.M., Konstantinova T.S., Mazurok L.A., Goriachok I.G., Korobkin A.V., Liubchenko M.A., Latyshkevich O.A., Zvereva A.V., Kurtser M.A., Savchenko V.G.

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