Clinical and immunological features of the course of pregnancy in women with Hodgkin’s lymphoma

Objective: to estimate the incidence of viral and bacterial infection in pregnant women with Hodgkin's lymphoma (HL) and the specific features of their immunity depending on the duration of remission or the activity of the disease. Setting: Research Center of Obstetrics, Gynecology, and Perinatology, Russian Agency for Medical Technologies, Moscow. Design: a prospective study. Subjects: 40 pregnant women with HL were examined in 2003 to 2006. According to the activity of the disease and the duration of remission, ail the females were divided into 2 groups: 1) 20 women in the active phase of the disease or with less than 5-year remission before the occurrence of pregnancy; 2) 20 women with more than 5-year remission. The data on immune and interferon states in Groups 1 and 2 women were compared with those in women with physiological pregnancy (a control group), which had been obtained at the Laboratory of Immunology, Research Center of Obstetrics, Gynecology, and Perinatology. Methods: immunological, molecular biological (PCR diagnosis) and serological studies, as well as statistical data processing by a package of applied programs (Excel, version 7.0). Results: pregnancy was normal in 6 (30%) Group і patients and 14 (70%) Group 2 patients with HL. Among the complications of pregnancy, virai and bacterial infections were most common in 12 (60%) females in Group 1 and in 4 (20%) in Group 2. Immunological study revealed a significant reduction in the absolute and relative count of lymphocytes: CD3 + and CD4 + phenotypes and a statistically significant increase in CD8 + (T killer cells) and CD16 +CG56 + (natural killer cells) in Group 1 pregnant women as compared with Group 2 and control group women. There was a statistically significant increase in the circulation of serum interferon (1FN) (6.5 U/ml) in Group 2 as compared with that in Group 1, which was equal to the norma! value (2 U/ml). In both Group I and Group 2, this was associated with a statistically significant reduction in IRL on α-IFN and γ-IFN inductors, as compared with the controls. The physical development and the incidence of congenital and acquired diseases in the babies bom to females who had sustained HL did not differ from those in the general population. Conclusion: the high incidence of viral and bacterial infections in pregnant women with an active stage of HL or a short (less than 5 year) remission was due to the signs of immunodeficiency as a result of both the disease itself and the use of polychemotherapy in radiotherapy. Therefore, the less than 5-year interval after chemotherapy, which is required to recover the activity of functional systems, should be regarded as the optimum time of pregnancy occurrence.