Zusammenfassung
Das Zusammentreffen von Neoplasien des blutbildenden und lymphatischen Systems mit einer Schwangerschaft ist nicht so selten, als dass damit nicht jederzeit zu rechnen wäre. Dabei sind aktuelle Fortschritte in Diagnostik und Therapie zu verzeichnen. Die verschiedenen Entitäten werden aktuell durch molekulargenetische und -biologische Techniken weiter differenziert; durch neue Kenntnisse wurden einige unter ihnen hochspezifisch, also effektiver und nebenwirkungsärmer behandelbar. Neue therapeutische Möglichkeiten eröffnen sich durch neue Chemotherapeutika, Immunmodulatoren, Zytokine und supportiv wirksame Medikamente. Mit der Sonographie gelingt es zuverlässiger, die Beeinträchtigung von Plazenta und Fetus darzustellen. Die Magnetresonanztomographie erlaubt die Messung von Tumormenge und -verteilung und hilft durch genauere Lokalisation, die Belastung durch evtl. notwendige Röntgenbestrahlung zu vermeiden. Fortschritte der Neonatologie erleichterten die sehr frühe Entbindung, um der Mutter auch hochwirksame intensivierte und meist auch nebenwirkungsreiche Verfahren zukommen lassen zu können. Somit können in interdisziplinärer Zusammenarbeit inzwischen etliche neue Möglichkeiten für die Diagnostik und Behandlung der Leukämien und Lymphome in der Schwangerschaft mit Erfolg ausgeschöpft werden.
Abstract
Coexistence of pregnancy and leukemia or lymphoma is not a rare condition in women of childbearing age. Today, many specific modalities are efficacious and can become adjusted to the situation of a mother bearing the unborn child. Therapeutic modalities have been improved by a higher precision of radiotherapy and a wider range of cytotoxic therapeutics, biological drugs and the possibility of the delivery of a premature child, which was achieved through better intensive care on specialized neonatal wards. Improved magnetic resonance imaging defines the extent of the disease, saving X-ray doses. Stronger supportive care helps mothers to tolerate side effects of the cytotoxic schedules, which are successfully used for these diseases in non-pregnant patients. For special subtypes new specific therapeutic options are available. More cytotoxic antibodies are to come soon and enrich our arsenal of biologic and targeted drugs. Today, the interdisciplinary approach of gynecologist, pediatrician and oncologist or hematologist offers a promising and the only appropriate means to deal with the complex task, to treat a mother with her unborn child for a hematologic malignancy.
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Pralle, H.B., Weber, C. Hämatologische Neoplasien und Schwangerschaft. Gynäkologe 38, 119–126 (2005). https://doi.org/10.1007/s00129-004-1648-y
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DOI: https://doi.org/10.1007/s00129-004-1648-y