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 Leukemia is a
cancer of the blood-forming tissues in which millions of abnormal white blood
cells crowd out normal ones.
The occurrence of leukemia during pregnancy is very rare with an estimated
incidence of one per 100,000 pregnancies annually. It has been estimated that
during pregnancy most leukemias are acute: two thirds are
myeloid (AML) and one
third are lymphatic (ALL).
Chronic myeloid leukemia (CML) is found in less than
10% of leukemias during pregnancy and chronic lymphocytic leukemia (CLL) is
extremely rare.
The
survival of pregnant and non-pregnant women with acute leukemia has improved
with the availability of modern chemotherapy and supportive care. Remission
rates of 70-75% and median survival time of 6 to12 months are currently reported
for pregnant women. These figures are not different from those achieved in
non-pregnant women with acute leukemia.
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A
mother's exposure to any type of pesticide in her home during pregnancy
can contribute to twice as much risk of her child developing leukemia,
compared with mothers reporting no pesticide exposure. |
 Acute leukemia can affect pregnancy and the fetus.
Intrauterine growth retardation has been reported in mothers not treated with
chemotherapy.
In
addition, preterm labor, induced and spontaneous abortion as well as still birth
are common in acute leukemia.
Although
there is an estimated teratogenic risk rate of 10% when chemotherapy is
administered in the first trimester, no fetal malformations and no late side
effects have been reported in children born to mothers who were treated for
acute leukemia during early pregnancy .
Treatment
It is
generally believed that pregnant women should be treated as non-pregnant women.
Therapeutic abortion should be considered in early gestation, but if the woman
decides to continue the pregnancy certain drugs, like methotrexate, should be
replaced. Standard anti-leukemic treatment can be safely administered during the
second and third trimesters. Delivery should be accomplished when fetal survival
can be ensured and the mother is in complete remission. There are rare reports
of leukemia blasts infiltrating the placenta and a single case of infantile
acute monocytic leukemia caused by vertical transmission of the mother's
leukemia cells.
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Five
cases of relapse of ALL in pregnancy have been reported in the medical
literature. The mechanisms attributable to the immunologic and hormonal
changes of pregnancy have been postulated. All five patients were treated
between 2 weeks and 4.5 months with cytotoxic chemotherapy with the fetus
still in utero. Four out of five patients delivered healthy and normal
infants and an elective abortion was reported. Unfortunately, all mothers
except one died of their disease in under 2 years. |
 Chronic
myeloid leukemia during pregnancy should be treated as in the nongestational
patients. Since the disease has an initial chronic phase, it is usually managed
conservatively during pregnancy, while an aggressive approach, such as
bone
marrow transplantation, may be considered after delivery. A limited number of
cases described successful treatment modalities of CML during pregnancy
including
leukapheresis,
hydroxyurea and
interferon.
Pregnancy
complicated by hairy cell leukemia is extremely rare.
Splenectomy is a safe and effective treatment option during the second
trimester for this rare condition Single cases have been treated with
interferon during pregnancy.
Prevention
-
 Folate
supplements taken by pregnant women may also
protect babies from leukemia.
-
 A
new
study, suggests that women who eat more vegetables, fruit and
foods
containing protein before pregnancy may have a lower risk of having a
child who develops leukemia, the most common childhood cancer in the United
States.
The study,
published in the August 2004 issue of Cancer Causes and Control, is the first
time researchers have conducted a systematic survey of a woman's diet and linked
it to childhood leukemia risk.
Within the
fruit and vegetable food groups, certain foods - including carrots, string beans
and cantaloupe - stood out as having stronger links to lower childhood leukemia
risk. The researchers point to the benefits of nutrients, such as
carotenoids,
in those foods as potential protective factors.
The
researchers looked further and found that glutathione was the nutrient in the
protein group with a strong link to lower cancer risk. Glutathione is an
antioxidant found in both meat and legumes, and it plays a role in the synthesis
and repair of DNA, as well as the detoxification of certain harmful compounds.
National guidelines recommend that people eat at least five servings of fruits
and vegetables every day, and two to three servings of foods from the protein
group.
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