Immediate Therapy

According to anecdotal case series, most non-Hodgkin lymphomas (NHLs) in pregnant patients are aggressive, and delay of therapy until after delivery appears to have poor outcomes.[1-4] Consequently, some investigators favor immediate therapy, even during pregnancy.[4] In a review of 121 patient case reports from 74 papers, one-half of the patients had very aggressive lymphomas, such as Burkitt lymphoma, and one-half of the patients had involvement of the breast, ovaries, uterus, or placenta.[5] One-half of the patients received therapy antepartum, and the 6-month survival rate was 53%, with a live-birth rate of 83%.[5][Level of evidence C3]

A multicenter retrospective analysis of 50 patients described pregnancy termination in 3 patients, deferral of therapy to postpartum in 15 patients (median 30 weeks gestation), and antenatal therapy in the remaining 32 patients (median 21 weeks gestation, all done after the first trimester).[6] With a median follow-up of 41 months, the 3-year progression-free survival rate was 53%, and the overall survival rate was 82%, using R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) or modifications of this regimen.[6][Level of evidence C3]