Most Lymphoma Patients Who Relapse During Pregnancy Can Have a Live Birth

A majority of patients with lymphoma who relapse during pregnancy can have a live birth, even if treatment is initiated antenatally, according to a study published in Blood Advances.

The study also suggested that delaying treatment may negatively affect progression-free survival (PFS) but not overall survival (OS) in these patients.

In this retrospective analysis of data from 10 academic centers, the researchers identified 23 patients with relapsed/refractory lymphoma diagnosed during pregnancy from 1989 through 2021.

Most patients (78%) had classic Hodgkin lymphoma (cHL). The median time from initial lymphoma diagnosis to relapse was 38 months (range, 10-246 months). The median gestation at the time of relapsed/refractory diagnosis was 22 weeks (range, 5-30 weeks).

A total of 14 patients (61%) deferred treatment until after pregnancy, and 5 (22%) received therapy during pregnancy. Of the 5 who received treatment antenatally, 4 had a complete response.

Most patients (83%) had a live birth at a median gestation of 36 weeks. Of these, 58% were considered preterm births (less than 37 weeks), with 73% initiated by the clinician so the patient could begin systemic therapy.

Pregnancy-related complications occurred in 5 patients and included preeclampsia (n=1), gestational diabetes (n=2), and infectious complications (n=2). All of these patients had deferred therapy until after delivery, the researchers reported.

At a median follow-up of 37 months, the estimated 3-year PFS rate was 24%, and the estimated 3-year OS rate was 83%. For patients with cHL, the PFS rate was 0%, and the OS rate was 71%. 

“It is possible that the compromised PFS seen for patients in this series was attributable to the delayed initiation of systemic therapy, which was over 4 months from diagnosis to start of treatment for patients who had therapy deferred,” the researchers noted.

“As the therapeutic indications for immunotherapy broaden across several different cancers and the integration of targeted therapeutic agents become part of standard therapy, there is an increased need to understand the efficacy and safety of these agents for pregnant people with cancer,” the researchers wrote. 

They concluded that “research of these uncommon and complex cancer cases is warranted.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Farooq F, Brandt JS, Cardonick E, et al. An international real-world analysis of relapsed/refractory lymphoma occurring during pregnancy. Blood Adv. Published online June 1, 2023. doi:10.1182/bloodadvances.2023010090