Clinical Analysis And Literature Review Of 26 Patients With Hematological Malignancies During Pregnancy

Objective Analyze and discuss the clinical characteristics,diagnosis,treatment experience and prognosis of hematological malignancies in pregnancy,improve the understanding of hematological malignancies in pregnancy。Methods Retrospectively summarized and analyzed the clinical data of patients with hematological malignancies during pregnancy who were admitted to the General Hospital of Ningxia Medical University from January 2001 to February 2021 for statistical analysis,combine literature retrieval and discuss.Results(1)Incidence rate: The incidence rate of 26 pregnant women with hematological malignancies in the 36123 pregnant patients admitted to our hospital during the same period was about 0.07%,with a median age of 26(18-39)years old,except for 1 patient who was diagnosed before pregnancy,the incidence rates of the first,second and third trimester of pregnancy were 12%(3/25),48%(12/25),and 40%(10/25),respectively;(2)Type of disease: Among those 26 patients pregnant during hematological malignancies,12 cases were pregnant with acute myeloid leukemia(AML)(46.2%,12/26),among them,there were5 cases of acute promyelocytic leukemia(APL or AML-M3)and 7 cases of AML(non-M3),3 cases(11.5%,3/26)of acute lymphoblastic leukemia(ALL),2 cases(7.7%,2/26)pregnancy with Hodgkin lymphoma(HL),8 cases(30.8%,8/26)of non-Hodgkin lymphoma(NHL),1 case(3.8%,1/26)with chronic myeloid leukemia(CML);(3)Treatment status: 12 cases of the 16 leukemia patients received chemotherapy,and a total of 7 patients(58.3%)achieved complete remission(CR)after the initial chemotherapy.In the 5 cases of APL,4cases of the first diagnosis received CR.The other 1 case of APL diagnosed before pregnancy received CR after treatment.The pregnancy was terminated in the early pregnancy and chemotherapy was continued.Of the 7 AML(non-M3)patients,5 received treatment,3achieved CR(60%),1 case of 3 ALL patients did not achieve CR after treatment,and 1 CML patient did not respond to chemotherapy;(4)Pregnancy treatment and pregnancy outcome: 11 of the 26 patients(42.3%,11/26)chose to therapeutic induction or artificial abortion,(3 cases in the first trimester,7 cases in the second trimester,and 1 case in the third trimester),The other 15 patients who continued pregnancy(1 in the first trimester,,4 in the second trimester,and 10 in the third trimester),2 cases died in the second trimester of pregnancy(2/15,13.3%),and 2 cases of fetal death(1 case of spontaneous abortion,1 case of intrauterine death)),11patients(42.3%,11/26)finally gave birth to fetuses(1 in the second trimester and 10 in the third trimester),of which 6 cases were healthy newborns(54.5%,6/11),5 Cases with adverse neonatal complications(45.5%,5/11,3 cases of low birth weight infants,2 cases of neonatal respiratory distress syndrome,1 case of neonatal asphyxia).Adverse pregnancy outcomes occurred in 8 of 15 patients with continued pregnancy(53.3%).Among the 11 fetuses successfully delivered,except 2 cases were lost to follow-up,9 newborns survived long-term follow-up and didn’t found abnormal physical or psychological development;(5)Follow-up and survival: The average survival period of 26 patients was(72.5±9.7)months,the 1-year cumulative survival rate was 74.3%,the 3-year cumulative survival rate was 67.5%,and 7deaths(26.9%,7/26)were all leukemias.Among the 26 patients,the median survival time of16 patients with leukemia in pregnancy was 28(1 ～ 103)months,the 1-year cumulative survival rate was 57.9%,and the 3-year cumulative survival rate was 46.3%;the median survival time of 10 patients with lymphoma in pregnancy was 33.5(1～87)months,except for 2 cases that were lost to follow-up,the other 8 cases were alive.The survival time of patients with leukemia in pregnancy was shorter than lymphoma in pregnancy(p<0.05).Conclusion Hematological malignancies in pregnancy are a rare and special clinical condition,with a low incidence.Acute leukemia and lymphoma are the most common in the second and third trimester of pregnancy.The survival and prognosis of APL and lymphoma are better,but the prognosis of ALL is relatively poor.Patients with hematological malignancies in pregnancy have a higher incidence of adverse pregnancy outcomes,but the long-term survival and prognosis of the fetus after delivery in the third trimester of pregnancy are fair.For patients with hematological malignancies in the first trimester of pregnancy,it is recommended to terminate the pregnancy as soon as possible.If patients with leukemia in the second and third trimester choose to continue pregnancy,individualized treatment regimens should be formulated based on various factors.For patients with early lymphoma in the third trimester of pregnancy,they can wait for further treatment after delivery as appropriate.