PREGNANCY DURING THERAPY FOR CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA -2 CASE-REPORTS AND A REVIEW OF THE LITERATURE

Purpose: The incidence and consequences of pregnancy during therapy fo r childhood acute lymphoblastic leukemia (ALL) are largely unknown. To explore the issues involved in this complication of ALL treatment, tw o recent cases are presented. Patients: Two 15-year-old girls with ''h igh risk'' ALL became pregnant while receiving maintenance therapy. Re sults: In one case, the patient experienced a spontaneous abortion at approximately 5 to 6 weeks gestation. The patient completed maintenanc e therapy and is in remission 8 months after the end of treatment. The second patient, known to be non-compliant during therapy was found to be 5 months pregnant at the end of maintenance therapy. She developed HELLP syndrome (hemolysis, elevated Liver enzymes, and low platelet c ount), was induced at approximately 34 weeks, and delivered an apparen tly normal baby girl. Both the patient and her baby continue to do wel l 10 months after delivery. Conclusions: A variety of factors may infl uence the incidence of pregnancy during ALL therapy Gonadal function, which is likely to return to normal during maintenance therapy, may al so be affected by alterations in the dose intensity of treatment. Soci al factors may also alter the incidence of pregnancy. Adverse effects on the fetus are more Likely to occur in the first trimester, dependin g on the drug or drugs used. Although all chemotherapies may have muta genic and teratogenic effects, they do not invariably cause abnormalit ies. Survival of adolescents who become pregnant during treatment does not appear to be adversely affected when therapy is not modified or d iscontinued.