Introduction: Lymphomas, notably Hodgkin lymphoma, are the fourth most common cancer during pregnancy, occurring at a frequency of 1 in 1000 to 6000 pregnancies. Hodgkin lymphoma during pregnancy is documented in 3.2% of all diagnosed patients. Guidelines recommend initiating the ABVD regimen at a specific week of pregnancy or using treatments involving anthracyclines and vinca alkaloids.
Material and Method: The evaluation considered active treatment, encompassing both chemotherapy and radiotherapy regimens, and assessed their effects on the health of both the mother and the child. During systemic treatment administered during pregnancy, the EVA regimen (etoposide, vincristine, doxorubicin administered in cycles every 28 days) was employed in 53 patients, with an additional 5 undergoing radiotherapy. Systemic EVA therapy was predominantly administered during the second and third trimesters, with 77.4% (41 patients) receiving it during the second trimester. On average, three courses were administered, with a maximum anthracycline dose of 320 mg (median 180 mg). Most frequently, doses ranging from >120 mg to 240 mg were given, with 25 (47.2%) pregnant patients receiving them. Throughout EVA therapy, fetal status, umbilical vessels, and the placenta were monitored via ultrasound examination. Causal treatment was continued up to 3 weeks before delivery.
Results: The median follow-up duration for patients was 12.65 years. For the 53 patients treated with the EVA regimen during pregnancy: the 5-year overall survival was 88.4% (95% confidence interval [CI] 80.1% - 97.6%), and the 5-year progression-free survival was 76.8% (95% CI 66.1% - 89.3%). Out of 53 patients treated with EVA, 48 achieved complete remission before delivery. Among these, 8 experienced recurrence after 1 to 9.8 years. Growth factors were not administered to patients as part of the EVA regimen. Neutropenia was observed in some patients, as well as anemia, which did not require specific treatment.Complications around childbirth were not observed. No hematologic complications were noted in newborns except for grade 1 neutropenia in one child, which lasted for 4 days after birth. All children are developing normally.
Conclusions: The EVA regimen is a viable therapy for Hodgkin lymphoma in pregnant women. These findings support incorporating EVA therapy into clinical guidelines. Further research should address long-term outcomes and chemotherapy safety in this patient population.
Elżbieta Wojciechowska-Lampka, Magdalena Rosińska, Jacek Lampka, Zbigniew Nowecki, Włodzimierz Osiadacz, Joanna Tajer, Joanna Romejko-Jarosińska