CCoPE
Date: 2000-07-25

Question:
We have admitted a 32 year old woman in the 12th week of a normal pregnancy with the first diagnosis of acute lymphoblastic leukemia (probably c-ALL, results pending). We will try to preserve the pregnancy while maintaining the dose intensity of chemotherapy. Our questions are: Is the use of L-asparaginase possible? Is the use of MTX 15 mg intrathekal possible? Are there experiences with similar cases?

Answer:
This is a very complicated case and many data are not provided-thus we will have to relate to the main and principle issues involved in this case:
1.The risk of teratogenesis associated with multiagent chemotherapy is estimated to be 25%. However,there are case reports and small case series of patients with acute leukemia that were treated during pregnancy,including 1st trimester,and delivered normal babies. For details please see our statement on Leukemia, under Specific Cancers in Pregnancy

2.Methotrexate is considered to be one of the stongest teratogens among the chemotherapeutic agents. However this effect is probably dependent upon the dose and time of administration. The dose of 15 mg to the csf is small, although there is an absorption to the systemic circulation. Again there are reports of women that delivered normal babies even when higher doses of mtx were administered intravenously. See our Cancer in Pregnancy section of this website for more details.

3.I am not aware of specific reports on asparaginase during pregnancy. However it was a part of the treatment protocol in some cases that resulted in normal babies.

4.There are reports of similar cases. There is probably a publication bias and thus no clear cut conclusions can be reached. Nevertheless,it is clear that patients with ALL were treated during pregnancy and delivered normal babies. However the risk to the mother and the fetus is significant and should be seriously considered.

5.The babies that were born were often of low birth weight. However they had normal physical and intelectual development. There are also reports of normal sexual development.There were no fertility disturbances and no malignancies.

We hope you will share any new data or findings you uncover during the management of your patient.