Chronic myelogenous leukemia: a concise update

Although cancer during pregnancy is infrequent, its management is difficult for patients, their families, and their physicians. When termination of the pregnancy is unacceptable, decisions regarding the use of irradiation and chemotherapy are complicated by the well-known high risks of abortion and fetal malformation. This risk is concentrated in the first trimester and varies with the choice of chemotherapeutic agents or combinations of agents. There is only minimal evidence of increased risk of malformation or abortion in the second or third trimester. Recent progress in cancer therapy has made cure a reasonable goal, and for some malignant neoplasms, cure is still possible even when initial therapy is modified or delayed. When cure is a reasonable goal, curative therapy should not be compromised by modification or delay. When treatment for cure or significant palliation is not possible, however, the goal should shift to protection of the fetus from damage by the injudicious use of teratogenic cancer therapy. This report will review the available data that may assist in these difficult decisions.

Management of Cancer During Pregnancy

Hyperleukocytosis, leukostasis and leukapheresis: practice management.

Therapy of small cell lung cancer: a perspective on two decades of clinical research.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61348-2.pdf

Haematological cancers in pregnancy

Leukapheresis was used as the sole modality of treatment of a patient with chronic myelogenous leukemia (CML) during her pregnancy The specific requirements for safe leukapheresis during pregnancy are discussed, and the literature describing the management of CML during pregnancy is reviewed Leukapheresis may be the treatment of choice in selected pregnancy patients with CML since it avoids the potential teratogenic effects of chemotherapy or radiation therapy

Leukapheresis for control of chronic myelogenous leukemia during pregnancy

A case of metastatic uterine papillary serous carcinoma with a complete response to chemotherapy is reported. The patient presented with vaginal, pelvic, and lymph node metastases 11 months after primary surgical resection was performed. A complete response to cyclophosphamide, Adriamycin (doxorubicin), and cisplatin was achieved. In this histologic pattern of endometrial adenocarcinoma, which behaves clinically like epithelial ovarian cancer, combination chemotherapy can offer significant response and palliation.

Uterine papillary serous carcinoma. Complete response to combination chemotherapy.

All patients with limited-stage small cell lung carcinoma (SCLC) diagnosed between January 1975 and 1981 in Rochester, New York, were collected. One hundred one patients were evaluable. By reviewing an entire community' s experience with long follow-up, we were able to describe the response rates and survival in a large unselected population and compare them to results from concurrent cooperative group studies. Median survival for the entire group was 51 weeks, with only 18% alive at 130 weeks. There was no evidence for improvement in response or survival during the 6 years of study. Treatment results in the community as a whole were no different from that seen with cooperative group studies. A group who had initial surgery followed by adjuvant therapy had a significantly better survival and more long-term survivors than those not receiving surgery, but rare long-term survivors were seen with all treatment categories. Except for this small surgical subgroup, no other characteristics could be identified which were predictably associated with long-term disease-free survival. The overall poor survival of patient with localized SCLC suggests a need for the development of novel initial approaches to therapy.

Denis Fitzgerald

Papers

Leukapheresis for control of chronic myelogenous leukemia during pregnancy

Uterine papillary serous carcinoma. Complete response to combination chemotherapy.

Long-term survival in limited-stage small cell lung carcinoma: Experience in Rochester, New York from 1975 to 1981