The incidence of hematologic malignancies presenting during pregnancy has increased, so Georgia Mills, MBBS (Hons), FRACP, FRCPA, of Northern Beaches Hospital in Sydney, Australia, and colleagues published a Position Statement in The Lancet Haematology outlining recommendations for diagnosis, imaging safety, and treatment in this patient cohort.
The authors searched Medline, PubMed, Embase, and Scopus for studies reporting on outcomes in women treated for acute leukemia and aggressive lymphoma during pregnancy. Based on their analysis, they recommended a multidisciplinary, collaborative approach to care for patients, and advised standard-of-care treatment unless specifically contraindicated to optimize survival outcomes. They also noted that early engagement with psychology services and support groups is crucial as this pregnant patients experience an increased rate of depression and anxiety.
Guidance recommendations
Based on the literature and expert opinion, they made several other recommendations, including the following:
- Timely histopathological diagnosis is necessary via bone marrow aspirate and trephine or lymph node biopsy or both. Local anesthetic and methoxyflurane are safe for use in all stages of pregnancy and can be used during these diagnostic procedures.
- Imaging modalities without ionizing radiation are considered safe in this cohort. There is a negligible to low risk to the fetus from radiation doses associated with any single diagnostic imaging study. However, they noted that radiation can potentially ionize fetal tissue, leading to fetal effects.
- Termination of the pregnancy when hematologic malignancies are diagnosed in the first trimester should be considered and assessed for risks to both the mother and fetus.
- Fetal growth and wellbeing should be regularly assessed with serial fetal ultrasounds, particularly if chemotherapy is given. Birth should be planned at a tertiary hospital with appropriate neonatal facilities, a maternal high-dependency unit, and blood bank.
- There is an increased risk of postpartum hemorrhage in patients with hematologic malignancies, particularly acute leukemia, so preventive strategies are recommended, including early recognition and intervention.
- Mothers should be counseled and advised on breastfeeding options based on recent and ongoing chemotherapy treatment.
“In providing optimal care, close communication, shared decision-making, and maintaining focus on the goals of a successful pregnancy outcome and a complication-free survival are necessary. Evidence-based and empathic multidisciplinary care is crucial to achieve these aims,” the authors concluded.
Reference
Mills G, Shand A, Kennedy D, et al. Position statement on the diagnosis and management of acute leukaemia and aggressive lymphomas in pregnancy. Lancet Haematol. 2025;12(2):e151-e162. doi:10.1016/S2352-3026(24)00309-0
