Introduction/Background Acute lymphoblastic leukemia (ALL) during pregnancy represents a challenging disease for both physicians and pregnant women. We present a rare case of a 26-year-old primigravida diagnosed with ALL at 23 weeks of gestation, treated with a modified German multicenter ALL (GMALL) protocol, who gave birth to a healthy baby-girl at 31 weeks of gestation.
Methodology A 26-year-old primigravida presented at 23 weeks of gestation with persistent leukocytosis with 67,4% B-lymphoblasts. Bone marrow biopsy conducted in 23+2 weeks of gestation revealed precursor B-cell Acute Lymphoblastic Leukemia (ALL).
Continuation of pregnancy was decided after counselling and a personalized treatment protocol was initiated. The patient received 4 mg of dexamethasone per day, combined with 300 mg of allopurinol.
Fetal development was within normal range but during this stage, the patient presented neutropenia and anemia. Treatment continued with 4 doses of 50 mg doxorubicin, combined with filgrastim, 2 mg of vincristine and 20 mg of dexamethasone every 7 days.
Results At 30 weeks of gestation fetal echocardiography revealed a small pericardial effusion, increased flow velocity, small right ventricular dilatation and a patent ductus arteriosus aneurysm, compatible with cardiac insufficiency either due to chemotherapy-induced cardiotoxicity or due to utero-placental insufficiency. Chemotherapy was discontinuated and a ceasarean section was performed at 31+4 weeks-of-gestation giving birth to a baby girl of 1670gr, with an Apgar score ≥7 at 1 min and ≥8 at 5 min.
Conclusion ALL requires immediate treatment, regardless of gestational age. Pregnancy termination and risks from chemotherapy should be discussed thoroughly with the patient. More studies are required to determine the prognosis of ALL during pregnancy and the long-term impact of the disease and the CBC on the fetus.
Disclosure Nothing to disclose.
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