Haematological cancer

Hematological cancer is the second most frequent cancer during pregnancy. Hematological malignancies are uncommon during pregnancy. Nevertheless, it includes a very complex medical, but also ethical and psychological problem. Diagnosis is frequently delayed because of an overlap of the disease- and gestation-related symptoms, and limitations of imaging studies (PET-CT). Delay in diagnosis and treatment will influence the prognosis for acute leukemia and aggressive/advanced lymphomas, and may influence the prognosis for chronic leukemia and indolent non-Hodgkin lymphomas. In selected cases with limited disease of early stage Hodgkin’s disease, treatment may be safely postponed until after delivery. As in other cancer types, a multidisciplinary staging strategy is the best guarantee to reduce radiation exposure to the fetus. The decision to use chemotherapy during pregnancy must be carefully weighed against the effect of treatment delay on maternal survival. If possible, chemotherapy should be avoided during the first trimester or abortion should be taken in consideration. If the mother decides to continue the pregnancy and multidrug treatment in first trimester is required, anthracycline antibiotics, vinca alkaloids or single-agent treatment followed by multi-agent therapy after first trimester should be considered. Use of chemotherapy (ABVD, R-CHOP) in the second and third trimesters may be considered safe. Radiotherapy during pregnancy is possible, if the fetal exposure does not exceed the threshold dose of 100mGy. Seen the complexity of the decisions in treatment of pregnancy-associated cancer, this  should be approached interdisciplinary and should be individually for each patient. Every decision should be made together with the patient, after careful balancing of both the risks and benefits.