Leukemia in pregnancy and fetal response to multiagent chemotherapy

Background: Leukemia is rare in pregnancy and treatment with intensive, mul tiagent chemotherapy produces complete remission in most adults, but might have deleterious effects on fetuses. Case: A 24-year-old gravida 3 para 2 presented at 24 weeks with pruritus, r ash, pancytopenia, and hepatitis. A bone marrow biopsy found acute lymphocy tic leukemia. She completed three cycles of intensive multiagent chemothera py with transient oligohydramnios in each cycle. Although there was decreas ed fetal growth rate, umbilical artery Doppler scans were normal. She deliv ered a normal 2150-g male infant at 36 weeks. Conclusion: Pregnant women with newly diagnosed leukemia should not delay t reatment, but multiagent chemotherapy might have transient effects on fetus es, most notably oligohydramnios. However, if fetal testing is normal, deli very might not be indicated. (C) 2001 by The American College of Obstetrici ans and Gynecologists.