The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance

Pietro R Di Ciaccio; Georgia Mills; Michael J Shipton; Belinda Campbell; Gareth Gregory; Jenna Langfield; Matthew Greenwood; Sean McKeague; Mohammad Shanavas; Renee Eslick; Giselle Kidson-Gerber; Portia Smallbone; Catherine Tang; Kirk Morris; Ian Bilmon; Costas K Yannakou; Xavier Badoux; Leanne Berkahn; Sergio Farina; Kylie D Mason; Penelope Motum; Kathryn Goss; Nada Hamad

doi:10.1111/bjh.18727

The clinical features, management and outcomes of lymphoma in pregnancy: A multicentre study by the Australasian Lymphoma Alliance

Br J Haematol. 2023 Jun;201(5):887-896. doi: 10.1111/bjh.18727. Epub 2023 Mar 7.

Authors

Pietro R Di Ciaccio^{1

2

3}, Georgia Mills^{4

5}, Michael J Shipton^{6

7}, Belinda Campbell^{7

8

9}, Gareth Gregory¹⁰, Jenna Langfield¹¹, Matthew Greenwood^{11

12}, Sean McKeague¹³, Mohammad Shanavas^{13

14}, Renee Eslick¹⁵, Giselle Kidson-Gerber^{16

17}, Portia Smallbone¹⁸, Catherine Tang^{19

20}, Kirk Morris²¹, Ian Bilmon^{1

12

22}, Costas K Yannakou²³, Xavier Badoux²⁴, Leanne Berkahn²⁵, Sergio Farina²⁶, Kylie D Mason^{6

7}, Penelope Motum²⁷, Kathryn Goss¹⁰, Nada Hamad^{3

28

29}

Affiliations

¹ Sydney Adventist Hospital, Wahroonga, New South Wales, Australia.
² College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
³ School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.
⁴ Northern Beaches Hospital, Frenchs Forest, New South Wales, Australia.
⁵ Faculty of Medicine, Macquarie University, Ryde, New South Wales, Australia.
⁶ Royal Melbourne Hospital, Melbourne, Victoria, Australia.
⁷ Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁸ Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.
⁹ Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia.
¹⁰ Monash Health, Clayton, Victoria, Australia.
¹¹ Royal North Shore Hospital, St Leonards, New South Wales, Australia.
¹² Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
¹³ Mater Hospital Brisbane, Brisbane, Queensland, Australia.
¹⁴ University of Queensland, Brisbane, Queensland, Australia.
¹⁵ The Canberra Hospital, Garran, Australian Capital Territory, Australia.
¹⁶ Prince of Wales Hospital and The Royal Hospital for Women, Randwick, New South Wales, Australia.
¹⁷ Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia.
¹⁸ Fiona Stanley Hospital, Perth, Western Australia, Australia.
¹⁹ Gosford Hospital, Gosford, New South Wales, Australia.
²⁰ School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
²¹ Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
²² Westmead Hospital, Westmead, New South Wales, Australia.
²³ Epworth Freemasons, Epworth HealthCare, Melbourne, Victoria, Australia.
²⁴ St George Hospital, Kogarah, New South Wales, Australia.
²⁵ Auckland Hospital, Auckland, New Zealand.
²⁶ Royal Hobart Hospital, Hobart, Tasmania, Australia.
²⁷ Liverpool Hospital, Liverpool, New South Wales, Australia.
²⁸ Department of Haematology, St Vincent's Hospital, Sydney, New South Wales, Australia.
²⁹ School of Medicine, Sydney, University of Notre, Sydney, New South Wales, Australia.

PMID: 36880558
DOI: 10.1111/bjh.18727

Abstract

Lymphoma in pregnancy (LIP) presents unique clinical, social and ethical challenges; however, the evidence regarding this clinical scenario is limited. We conducted a multicentre retrospective observational study reporting on the features, management, and outcomes of LIP in patients diagnosed between January 2009 and December 2020 at 16 sites in Australia and New Zealand for the first time. We included diagnoses occurring either during pregnancy or within the first 12 months following delivery. A total of 73 patients were included, 41 diagnosed antenatally (AN cohort) and 32 postnatally (PN cohort). The most common diagnoses were Hodgkin lymphoma (HL; 40 patients), diffuse large B-cell lymphoma (DLBCL; 11) and primary mediastinal B-cell lymphoma (PMBCL; six). At a median follow up of 2.37 years, the 2- and 5-year overall survival (OS) for patients with HL were 91% and 82%. For the combined DLBCL and PMBCL group, the 2-year OS was 92%. Standard curative chemotherapy regimens were successfully delivered to 64% of women in the AN cohort; however, counselling regarding future fertility and termination of pregnancy were suboptimal, and a standardised approach to staging lacking. Neonatal outcomes were generally favourable. We present a large multicentre cohort of LIP reflecting contemporary practice and identify areas in need of ongoing research.

Keywords: counselling; lymphoma; neonatology; outcomes research; pregnancy.

Publication types

Observational Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Female
Hodgkin Disease* / drug therapy
Hodgkin Disease* / therapy
Humans
Infant, Newborn
Lymphoma, Large B-Cell, Diffuse* / drug therapy
Pregnancy
Retrospective Studies
Rituximab / therapeutic use
Treatment Outcome

Substances

Rituximab