This article reports two cases and reviews the literature regarding chemotherapy using anthracyclines during pregnancy. Twenty-six additional cases using this class of agents to treat malignancy during pregnancy are summarized from 18 reports for a total of 28 pregnancies. Final outcome of pregnancy is analyzed with regard to the following factors: diagnosis, gestational age at start of tberapy, total dose of anthracycline, number and type of agents used, neonatal pathologic findings and months of follow-up of infants. Final outcome of 28 pregnancies resulted in 24 normal infants including a set of twins in the current report. Limited pharmacokinetic information is inconclusive with regard to the appearance of anthracyclines and their known metabolites in placental or fetal tissue.
Cuncer 6k435-440, 1988.
ALIGNANCY DURING PREGNANCY represents a M therapeutic dilemma. Solid data from prospective or randomized studies do not exist. Information regarding various therapeutic maneuvers must be obtained from anecdotal reports involving diverse diagnoses and treatments. Animal data regarding the teratogenicity of chemotherapeutic agents is readily available.'
The rise in the frequency of pregnancy in the fourth decade and later, leads to the expectation that the clinician will be faced with an increase in incidence of malignancy during pregnancy. The majority of these patients will have a malignancy for which the anthracycline derivatives play an important role in treatment. This report summarizes 26 cases in which doxorubicin (Doxo) and/or daunomycin (Daun) were used during pregnancy and describes two additional cases. To our knowledge Case I is the first report of twin pregnancy in which chemotherapy was used with normal outcome.
Case Reports
Case I
A 17-year-old white woman presented in October I978 with anemia and leukopenia. A diagnosis of acute lymphocytic leukemia (Ll) was established. Induction and consolidation therapy were given using vincristine, daunomycin, and prednisone. Central nervous system prophylaxis was given using intrathecal methotrexate and cranial irradiation. The patient attained a complete remission within 6 weeks.