Modern principles of pregnancy management in patients with lymphomas


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Abstract

Objective. To study the characteristics of pregnancy course and analyze maternal and perinatal outcomes in patients with lymphomas, based on anticancer treatment during pregnancy. Materials and methods. An analysis of the evolution of approaches to pregnancy management resulting from a 31-year observation experience of 70 women with lymphomas has been carried out. There were 46 women with Hodgkin lymphoma (LH) and 24 women with non-Hodgkin lymphoma (NHL). Patients were divided into three groups based on the time and tactics of their treatment: group 1 - without lymphoma treatment during pregnancy (n=7); group 2 - chemotherapy during pregnancy and mostly preterm delivery at 34-35 weeks gestation (n=26); group 3 - chemotherapy during pregnancy and mostly term delivery (n=37). Results. Chemotherapy was performed in 35pregnant women (50%), and 27 patients (38.6%) were not treated. The most common complication of pregnancy in patients who received treatment was anemia (71.4% vs. 44.4%, p=0.03). Six treated patients (37.5%) with NHL and one patient with LH (5.3%) had a pregnancy complicated by catheter-associated thrombosis. In patients with NHL, the frequency of preterm labor was statistically significantly higher than in patients with HL (twofold, p=0.03). In 80% of cases, the cause of preterm labor was iatrogenic (the need to start or continue the treatment). The comparative analysis of the frequency of preterm birth showed a significant decrease of it over the past five years (from 57.7% to 27.8%, p=0.02). Premature delivery significantly affected the health of newborns and in 2/3 of cases, premature-born children needed treatment under the ICU conditions. Conclusion. There was no correlation between the health status of the newborn and the chemotherapy received by mother, the morbidity of children at birth was mainly due to their prematurity. The radical change in the management of patients over the past five years has reduced the frequency of premature births by two times (p=0.02), which accordingly contributed to the reduction in the morbidity of newborns.

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About the authors

Roman G. Shmakov

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Email: r_shmakov@oparina4.ru
MD, professor, Director of the Institute of Obstetrics

Aminat I. Akhmedova

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Email: akhmedovag@yandex.ru
postgraduate student

Evgeniya S. Polushkina

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Email: e_polushkina@oparina4.ru
PhD, senior researcher

Elena A. Demina

N.I. Pirogov National Medical and Surgical Center

Email: drdemina@yandex.ru
MD, professor

Yana K. Mangasarova

National Medical Research Center for Hematology

Email: V.k.jana@mail.ru
PhD, senior researcher

Gayane S. Tumyan

N. N. Blokhin National Medical Research Center of Oncology

Email: gaytum@mail.ru
MD, professor

Maria A. Vinogradova

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Email: mary-grape@yandex.ru
PhD, head of the Department of Reproductive Hematology and Clinical Hemostasiology

Sergey K. Kravchenko

National Medical Research Center for Hematology

Email: skkrav@mail.ru
PhD, associate professor, head of the Department of Intensive High-dose Chemotherapy for Hemoblastosis with a Hospital and Outpatient Facility

Vktor V. Zubkov

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov

Email: v_zubkov@oparina4.ru
MD, head of the Department of Neonatology and Pediatrics

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