Document Detail


Treatment of acute myeloid leukemia during the second and third trimesters of pregnancy.
MedLine Citation:
PMID:  16207105     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fortunately, the occurrence of acute myeloid leukemia (AML) during pregnancy is rare. We report a case of successful fetal outcome with standard induction and consolidation treatment in the second and third trimesters, respectively. A 37-year-old woman in her second trimester (21 wks) of pregnancy was found to have acute myeloid leukemia. She elected to maintain the pregnancy and underwent induction with cytarabine and idarubicin. Her hospital course was complicated by Pseudomonas vesicularis and gram-positive bacilli (not Bacillus anthracis) septicemia, but she obtained complete remission. After discharge, a fetal echocardiogram at 26 weeks revealed a mildly dilated right ventricle with mild systolic dysfunction, and the left ventricle appeared smaller than normal with mild systolic dysfunction. The patient then received consolidation therapy with high-dose cytarabine. On day 14 of consolidation, filgrastim 16 mug/kg was added to improve stem cell mobilization. A total of 19.8x10(6) CD34+ cells/kg were collected with a single apheresis session. At 37 weeks, she delivered a viable female infant weighing 3 lbs 12 oz. Fetal abnormalities included acrocyanosis, shallow sacral dimple, short digits and limbs, and prominent frontal skull with mild macrognathia. A postnatal echocardiogram revealed a moderate-sized membranous ventricular septal defect. The ventricular septal defect proved significant and required surgical repair at 5 months. Approximately 4 weeks after delivery, the mother underwent autologous peripheral stem cell transplantation. Unfortunately, 100 days after transplantation, she had a relapse of AML. After a brief remission from a second induction, the patient died.
Authors:
Dawn M Niedermeier; Debra A Frei-Lahr; Philip D Hall
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pharmacotherapy     Volume:  25     ISSN:  0277-0008     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-10-06     Completed Date:  2005-10-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1134-40     Citation Subset:  IM    
Affiliation:
Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antimetabolites, Antineoplastic / therapeutic use
Cesarean Section
Cytarabine / therapeutic use
Female
Fetal Monitoring
Filgrastim / therapeutic use
Humans
Leukemia, Myeloid, Acute / drug therapy*
Pregnancy
Pregnancy Complications, Neoplastic / drug therapy*
Pregnancy Outcome
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Stem Cells / drug effects
Chemical
Reg. No./Substance:
0/Antimetabolites, Antineoplastic; 121181-53-1/Filgrastim; 147-94-4/Cytarabine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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