Pregnancy management in patients with acute leukemia

Any variant of acute leukemia is characterized by a severe course of the disease, a high incidence of complications and mortality. For a long time, there was an opinion that when verifying hemoblastoses during pregnancy, its termination is required. Currently, studies and experience accumulated have shown that in most cases, a complete treatment of hemoblastosis can be carried out during pregnancy without the risk for developing any complications for both a mother and a fetus. The entire range of diagnostic studies is also carried out fully. The safety of pregnant women performing such diagnostically significant procedures as bone marrow puncture biopsy has been repeatedly confirmed. In most cases, a lumbar puncture with a study of the cerebrospinal fluid is also feasible to rule out leukemic lesions of the central nervous system. The choice of treatment tactics is carried out by a doctor depending on the type of hemoblastosis and its stage. The main methods of treatment include multicomponent chemotherapy, supportive treatment, replacement transfusion therapy, extracorporeal methods. In the first trimester, there is a high probability of an unfavorable outcome of pregnancy for both the mother and the fetus. But currently, polychemotherapy schemes have been developed that can be used in this period of pregnancy. The delivery period in patients with acute leukemia is determined individually. The resumption of special therapy is recommended not earlier than 3-4 weeks after birth in order to minimize the risk of developing infectious and hemorrhagic complications in the postpartum period. If it is necessary to continue chemotherapy in the postpartum period, lactation should be suppressed in the patient, since most drugs penetrate into mother's milk. The specific chemotherapy carried out does not exclude the possibility of developing various pathological conditions that can be regarded as complications of cytostatic therapy, because these conditions can also occur during a healthy pregnancy as a result of spontaneous mutations and the development of congenital anomalies in the fetus. In the 2ndand 3d trimesters, polychemotherapy is used with the drugs that are not able to overcome the hematoplacental barrier. Thus, the management of pregnancy in patients with acute leukemia is a difficult task, which is addressed by the joint efforts of hematologists and obstetricians and gynecologists.

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