CCoPE
Date: 2011-02-01

Question:
I have an 7-weeks (bHCG) pregnant patient who was diagnosed with stage III Hodgkin's disease, she is complet her chemotherapy with ABVD protocole. Last cycle of ABVD was administrated the 15th december 2010, so 7 week also!!! What do you think about the foetus risk?, do you advise interruption of the pregnacy?

Answer:

The following information should not replace the assessment and advice received from a physician (cancer specialist, obstetrician, or other healthcare provider). It is offered for informational and educational purposes only.

Chemotherapy is generally not recommended in the first trimester, due to an association with increased fetal malformation and increased frequency of spontaneous abortion. Case studies on the cytotoxic drugs specific to this regimen are summarized below.

Adriamycin (doxorubicin) has been detected in placental, cord and fetal tissue, suggesting that it does cross the placenta. Case reports of 10 human pregnancies with first trimester exposure to adriamycin yielded 9 normal outcomes and one infant born with imperforate anus and rectovaginal fistula. The child in question was exposed to other cancer therapies in addition to adriamycin.

Bleomycin has been shown to induce chromosomal aberrations in the marrow cells, though the clinical significance of this behaviour in fetal development is not known. Some case reports exist of mothers treated during the second and third with bleomycin and other antineoplastic agents for non-Hodgkin?s lymphoma and teratoma. Two cases were found of adverse fetal effects: one child, who was born at 28 weeks because of ventriculomegaly, had cerebral atrophy; the second had transient neonatal leukipenia and neutropnia. Contrary, normal growth and development was found in a group of 23 children exposed to bleomycin in utero.

Vinblastine exposure in the first trimester has been documented a few times. In one case series of 15 infants exposed in the first trimester to vinblastine, with procarbazine and nitrogen mustard resulted in a spontaneous abortion of a male fetus, at 24 weeks with four toes in both feet and partial syndactyly. Another infant in this case series exposed to vinblastine, with vincristine and procarbazine died of respiratory distress after birth at 37 weeks. This baby was found to have a secundum atrial septal defect during autopsy. In another case series, 4 women were exposed to vinblastine and other antineoplastic drugs in their first trimester. There were no congenital abnormalities and follow up between 3 and 19 years of age showed no abnormalities in development. In a last case series of 26 pregnant women exposed to cancer chemotherapy, one child was born with hydrocephalus following exposure to vinblastine at 3 weeks gestation. Another infant exposed to lomustine, vincristine, prednisone, and procarbazine from 1-6 weeks gestation and to vinblastine from 9 weeks gestation to term was born with cleft lip and palate.

Dacarbazine. A case series of 17 women treated with dacarbazine and other antineoplastic agents in their first trimester of pregnancy showed no congenital abnormalities. A second case series that identified four women treated during their first trimester, all of the exposed offspring were normal at birth. Overall, there is little data regarding the use of this chemotherapeutic drug in pregnancy.