Multidisciplinary collaborative approach to care is required for patients with hematological malignancies in pregnancy
By Elana Gotkine HealthDay Reporter
WEDNESDAY, Jan. 8, 2025 (HealthDay News) — In a new position statement published online Jan. 3 in The Lancet Haematology, guidelines are presented for the management of acute leukemia and aggressive lymphomas in pregnancy.
Georgia Mills, M.B.B.S., from Northern Beaches Hospital in Sydney, and colleagues developed a position statement on the diagnosis and management of acute leukemia and aggressive lymphomas in pregnancy, which pose a unique challenge as both maternal and fetal well-being must be considered.
The authors note that diagnosis of hematological malignancies can be challenging in pregnancy, but timely diagnosis is required, with either a bone marrow aspirate and trephine or lymph node biopsy, or both. Imaging modalities without ionizing radiation are safe in pregnancy, but effects of radiation should be considered. A multidisciplinary collaborative approach to performing imaging in pregnancy is recommended. Furthermore, a multidisciplinary approach to care is required. To avoid conflicting advice to patients, clear, consistent, multidisciplinary communication between teams is imperative. Unless contraindicated, patients should receive standard-of-care hematological management to optimize both relapse-free and overall survival. Consideration of oncological and pregnancy-based issues and their interactions is important. Key clinical considerations include the natural history of the underlying malignancy, parental wishes and expectations, and physiological changes in pregnancy that may impact pharmacokinetics. Access to nursing and midwifery specialists and comprehensive counseling relating to medication exposures during pregnancy and breastfeeding are recommended.
“In providing optimal care, close communication, shared decision-making, and maintaining focus on the goals of a successful pregnancy outcome and a complication-free survival are necessary,” the authors write. “Evidence-based and empathic multidisciplinary care is crucial to achieve these aims.”
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