The management of hodgkin lymphoma during pregnancy

Abstract

The peak incidence of Hodgkin lymphoma (HL) coincides with reproductive years, and about 0.5–1% of all HL patients present with concurrent pregnancy. Lymphoma is the most common hematologic malignancy complicating pregnancy, with an estimated incidence of HL-associated deliveries of between 1 in 1000 and 1 in 3000 pregnancies. The medical challenge of concurrent HL and pregnancy stems from the need to manage the potentially life-threatening malignancy while giving the developing fetus the best chance of reaching term fully intact. Essentially, two patients need to be managed: one with lymphoma and the other without, both of whom will be affected by the toxicity of any treatments. Religious, ethical, psychological, social, and cultural beliefs and attitudes of the patient and her partner, family, and physicians all can affect decision-making. Thus, management of the disease and pregnancy not only involves the therapeutic approach but also requires attention to alleviating fear and anxiety and supporting the patient’s emotional and social well-being. Current clinical practice for treating HL during pregnancy is based largely on case series, retrospective reports, and expert opinions. Therefore, management of HL during pregnancy requires that the advising clinician must balance the provision of expertise and knowledge about treatment options and prognosis with respect for ethical principles, compassion, and acceptance of patient autonomy.