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Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review

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Abstract

Management of acute myeloid leukemia during pregnancy (P-AML) is a challenging endeavor with limited evidence-based information available. To truly achieve the goal of improving P-AML patients, additional evidence-based research is necessary. We retrospectively reviewed cases of 17 patients diagnosed with P-AML, including seven for acute promyelocytic leukemia (APL) from January 2012 to June 2019. Among the non-APL, 90% patients (9/10) ended pregnancy prior to induction chemotherapy. The median intervals between diagnosis and start of chemotherapy were 5 days (range 1–14 days). Four patients elected to delay chemotherapy by more than one week. Of the seven APL patients, six received all-trans retinoic acid (ATRA) before the diagnostic molecular results. Five patients underwent cesarean sections (CS) and all newborns were alive (four preterm and one full-term deliveries). Overall, approximately 94% of the patients (16/17) are currently alive in remission. To treat P-AML patients in a safer manner, balancing the risk of progressing to advanced disease and proceeding with pregnancy is required. We consider a slight delay (less than 14 days) in the termination of pregnancy may not differ the prognosis to patients with non-APL. For APL, patients will benefit from prompt administration of ATRA for highly suspected cases.

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Funding

This study is supported by Zhejiang Technology Project of Medicine under Grant: 20181KY567 and 2018KY577.

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Authors and Affiliations

  1. Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, 216 Huansha Road, Hangzhou, Zhejiang, 310006, People’s Republic of China

    Yi-Wei Li, Shen-Xian Qian & Can Chen

  2. Department of Intensive Care Unit, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China

    Yi-Wei Li & Wei Hu

  3. Department of Obstetrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, HangZhou, People’s Republic of China

    Yang-Feng Xu

Authors
  1. Yi-Wei Li
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  2. Yang-Feng Xu
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  3. Wei Hu
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  4. Shen-Xian Qian
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  5. Can Chen
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Contributions

CC and QXS conceived and generally supervised the study. LYW, HW and XYF collected the clinical data and drafted the manuscript. CC and LYW helped in revising the manuscript. QSX gave final approval for the manuscript. All the authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Shen-Xian Qian or Can Chen.

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The authors declare that they have no conflict of interest.

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All the cases were identified during routine diagnostics, hence ethical approval and consent to participate is not applicable, except for the agreement that diagnostics was performed to solve the clinical question.

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Li, YW., Xu, YF., Hu, W. et al. Acute myeloid leukemia during pregnancy: a single institutional experience with 17 patients and literature review. Int J Hematol 112, 487–495 (2020). https://doi.org/10.1007/s12185-020-02938-2

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  • DOI: https://doi.org/10.1007/s12185-020-02938-2

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