Acute rnyeloblastic leukemia in pregnancy: a case report and review of the literature

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.

Acute myeloblastic leukemia; Pregnancy; Preterm delivery

[1] McClain C.R.: "Leukemia in pregnancy". Clin. Obstet. Gynecol., 1974, 17, 185.

[2] Lichtman M.A., Liesveld J.L.: "Acute myelogenous leukemia". In: Beutler E., Lichtman M.A., Coller B.S., Kipps T.J., Seligsohn U. (eds.). Williams Hematology, 6th ed., New York: McGraw-Hill 2001, 1047.

[3] Greer J.P., Baer M.R., Kinney M.C.: "Acute myelogenous leukemia". In: Lee G.R., Foerster J., Lukens J., Paraskevas F., Grrer J..P, Roggers G.M. (eds.). Wintrobe's Clinical Hematology, vol. 2, Giza, Egypt: Mass Publishing Co. 1999, 2272.

[4] Caliguri M.A., Mayer R.J.: "Pregnancy and leukemias". Seminars Oneal., 1989, 16, 338.

[5] Reynoso E., Shepherd F., Messner H.A.: "Acute leukemia during pregnancy: the Toronto Leukemia Study Group experience wtth long-term follow-up of children exposed in utero to chemotherapeutic agents". J. Clin. Oneal., 1987, 5, 1098.

[6] Aviles A., Neri N.: "Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero". Clin. Lvmphoma, 2001, 2, 173.

[7] Greenlund L.J., Letendre L., Tefferi A.: "Acute leukemia during pregnancy: a single institutionall experience with 17 cases". Leuk Lymphoma, 2001, 41, 571.

[8] Linker C.A.: 'Treatment of acute leukemia in adults". Current Opinion in Oncology, 1992, 4, 53.

[9] Peleg D., Ben-Ami M.: "Lymphoma and Leukemia complicating pregnancy". Obstet. Gynecol. Clin. North. Am., 1998, 25, 365.

[10] Mills G.B.: "Immunology of cancer in pregnancy". In: Allen H.H., Nisker J.A. (eds.). Cancer in Pregnancy. NewYork: Futura 1986.

[11] Horn E.H., Davies J., Kean L.: "Other hematological conditions'·. In: James D.K., Steer P.J., Weiner C.P., Gomk B. (eds.). High Risk Pregnancy Management Options. 2nd ed., W B Saunders, Philadelphia, 1999, 765.

[12] Byrne J., Mulvihill J.J., Myers M.H., Connelly R.R., Naughton M.D., Krauss M.R.: "Effect of treatment on fertility in long-term survivors of childhood or adolescent cancer". New Engl. J. Med., 1987, 317, 1315.

[13] Sorencen J.T., Gerld K .. Bodensteiner D., Holmes F.: "Effect of age on survival in acute leukemia 1950-1990". Cancer, 1993, 72, 1602.

[14] Aviles A., Diaz-Maqueo J.C., Talavera A., Guzman R., Garcia E.L.: "Growth and development of children of mothers treated with chemotherapy during pregnancy: current status of 43 children". Am. J. Hematol., 1991, 36, 243.

[15] Pizzuto J., Aviles A., Noriega L., Niz J., Morales M., Romero F.: 'Treatment of acute leukemia during pregnancy: Presentation of nine cases". Cancer Treat. Rep., 1980, 64, 679.

[16] Kawamura S., Suzuki Y., Tamai Y., Itoh J., Fukushima K.. Takami H.: "Pregnancy outcome among long-term survivors with acute leukemia". Int. J. Hematol., 1995, 62, 157.

[17] Hansen W.F., Fretz P., Hunter S.K., Yankowitz J.: "Leukemia in pregnancy and fetal response to multiagent chemotherapy". Ohstet. Gynecol., 2001, 97, 809.

[18] Catanzarite VA., Ferguson J.E. II.: "Acute leukemia and oreg nancy. A review and management of outcome, 1972-1982". Obstet. Gvnecol. Surv., 1984, 39, 663.

[19] Ali R., Oikalemkas, Ozcelik T., Ozkocaman V., Ozan U., Kim ya Y., Tunali A.: "Maternal and fetal outcomes in pregnancies complicated with acute leukemia: a single institutional experience with 10 pregnancies at 16 years". Leuk. Res., 2002, 1610, 1.

[20] Sutcliffe S.B., Chapman R.M.: "Lymphomas and leukemias . In: Allen H.H.. Nisker J.A. (eds.). Cancer in Pregnancy. New York: Futura. 1986.

[21] Sheikh S.S., Khalifa M.A., Marley E.F., Bagg A., Lage J.M.: "Acute monocytic leukemia (FAB MS) involving the plasenta associated with delivery of a healthy infant: case report and discussion". Int. J. Gynecol. Pathol., 1996, 15, 363.

[22] Dildy G.A. Ill.: "Maternal malignancy metastatic to the product of conception: A review". Obstet. Gynecol. Surv., 1989, 44, 535.

[23] Tivey H.: "The natural history of untreated acute leukemia". Annals New York Acad. Sci., 1955, 60, 322.

[24] Kawamura S., Yoshiike M., Shimoyama T., Suzuki Y., Itoh J ., Yamagata K. et al.: "Management of acute leukemia during pregnancy: from the results of a nationwide questionnaire survey and literature survey". Tohoku J. Exp. Med., 1994, 174, 167.

[25] Doll D.C., Ringenberg Q.S., Yarbro J.W.: "Management of cancer during pregnancy". Arch. Intern. Med., 1988, 148, 2058.

[26] Feliu J., Suarez S., Ordonez A., Garcia-Paredes L.M., GonzalesBaron M., Montero J.M.: "Acute leukemia and pregnancy". Cancer, 1988, 61, 580.

[27] Buekers T.E., Lallas T.A.: "Chemotherapy in pregnancy". Obstet. Gynecol. Clin. North Am., 1998, 25, 323.

[28] Zuazu J., Julia A., Sierra J., Valentine M.G., Coma A., Sanz M.: "Pregnancy outcome in hematologic malignancies". Cancer, 1991, 67, 703.

[29] Schafer A.: "Teratogenic effects of antileukemic chemotherapy". Arch. intern. Med., 1981, 141, 514.

[30] Morishita S., Imai A., Kawabaa I., Tamaya T.: "Acute myelogenous leukemia in pregnancy: Fetal blood sampling and early effects of chemotherapy". Int. J. Gynecol. Obstet., 1994, 44, 273.

[31] Antunez-de-Mayola J., Ahn Y.S., Temple J.D., Harrington W.L.: "Spontaneous remission of acute leukemia after the termination of pregnancy". Cancer, 1989, 63, 1621.

[32] Isada N.B., Stewart M., Powell S.: "Hematologic complications". In: Evans A.T., Niswender K.R. (eds.). Manuals of Obstetncs, 6th ed., Philadelphia, 2000, 68.