Abstract P070

Management and Follow-Up of Pregnancy in Patients Diagnosed with Hodgkin's Lymphoma

Background: Hodgkin's lymphoma (HL) is a rare lymphatic cancer during pregnancy, presenting significant management challenges. The overlap of HL diagnosis with pregnancy necessitates balancing optimal cancer treatment and fetal safety. This study aimed to develop management strategies and follow-up protocols for pregnant patients diagnosed with HL.

Methods: A comprehensive literature review was conducted, focusing on clinical guidelines, case reports, and recent advances in treating HL during pregnancy. Special attention was given to our experience managing HL patients.

Results: Over the past 15 years, at the Erebouni Medical Center, in collaboration with hematologists from the Yeolyan Hematology and Oncology Center, 25 successful cases of managing and delivering patients with lymphoma, including 12 with HL, were recorded. Among these, 4 patients planned pregnancies and delivered healthy children, while 8 were diagnosed with HL in the first or second trimester. For patients planning pregnancy with a stable HL diagnosis, conception is recommended post-chemotherapy. Delivery methods depend on the patient's condition, with both cesarean and natural births considered. For those with multiparous (2a or 5.1 by Robson classification) and a stable HL condition, similar planning and delivery methods are applied. If HL is diagnosed in the first or second trimester, pregnancy continuation depends on the patient's condition, her desire, and the tumor board's decision. For multiparous women, decisions depend on HL stage and chemotherapy timing feasibility. In case of HL relapse or necessary treatment, chemotherapy is recommended from the second trimester to avoid teratogenic effects. The risk to the fetus decreases after the first trimester, making it the optimal time to begin treatment. In the third trimester, chemotherapy can continue as in the second trimester or be postponed until delivery if HL is stable. Delivery timing is coordinated to minimize risks associated with cancer progression and treatment. Post-delivery follow-up includes continued treatment with oral contraceptives if necessary and careful monitoring of both mother and newborn health.

Conclusion: Managing HL during pregnancy requires a multidisciplinary approach to balance effective cancer treatment with fetal safety. Early diagnosis, trimester-specific treatment strategies, and careful follow-up are crucial for optimizing outcomes for both mother and child.

Authors

Norayr Ghukasyan, Poghosyan Andranik, Gharibyan Edita, Danielyan Lusine, Sahakyan Lusine, Marina Melik-Andreasyan, Heghine Khachatryan