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Antineoplastic Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Antineoplastic drugs most commonly used to treat chronic leukemia include antimetabolites (methotrexate, thioguanine, mercaptopurine, and cytarabine), anthracycline antibiotics (daunorubicin and doxorubicin), and plant alkaloids (vincristine). Alkylating agents are also used as antileukemic drugs. Notably, all of these drugs are cytostatic, although mechanisms differ (cytotoxicity, DNA, and protein synthesis suppression). Therefore, all antineoplastics have a very high potential for causing birth defects with exposure during embryogenesis because this period is characterized by the highest rate of cell division (hyperplasia) and increase in size (hypertrophy) during human life.
Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
Pregnancy does not alter the natural course of chronic leukemia, but there are potentially perinatal risks of placental insufficiency secondary to leukostasis, as well as maternal risks if left untreated. Diagnosis usually occurs in the fifth decade of life, so is rarely diagnosed during pregnancy. Patients with CML who conceive while taking imatinib are advised to discontinue use during pregnancy, with the majority of patients able to regain remission status postpartum [84].
Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Experience in the treatment of leukemia during pregnancy is limited. Without treatment, the median survival time for patients with acute leukemia is 2 months. With treatment, 65% to 75% of adults with ALL will gain complete remission; however, recurrence is common and only one-third of patients with ALL will be long-term survivors. A similar proportion of individuals less than 60 years of age treated for AML will achieve complete remission, with 40% of these experiencing eventual cure (241). Chronic leukemia is more indolent and can be successfully controlled with chemotherapy for a long period of time.
Granulocytic sarcoma causing long spinal cord compression: Case report and literature review
Published in The Journal of Spinal Cord Medicine, 2022
Shiyuan Han, Yongning Li, Tong Niu, Xin Wang, Zhimin Li, Xinyu Ren, Jun Gao
Malignant spinal cord compression is a rare event in leukemia. It has been reported that 0.3% leukemia cases develop metastasis, which lead to spinal cord compression.13 Additionally, among all the tumor types that cause compressive myelopathy, acute and chronic leukemia account for <3%.10 On reviewing the previously reported cases in the English literature, we found 10 similar cases (8 males) with spinal cord compression (detailed information given in Table 1 and discussed below).7–16 GS-associated spinal cord compression definitely proves fatal to CML patients, especially those who have not achieved optimal outcomes following standard treatments. It is believed that GS originates from the bone marrow, migrates through the Haversian canals, and makes its way to the spinal cord via the dura mater or paravertebral lymph nodes.9 The confirmation of GS diagnosis remains difficult owing to its rarity and varied presentation. The misdiagnosis rate is reportedly 25–47%; GS could be mistaken for Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, Ewing’s sarcoma, or other carcinomas, particularly when blast cells of GS remain poorly differentiated.18 Thus, it is important to summarize the characteristics of GS, especially those causing spinal cord compression, and the final outcome.
Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)
Published in Expert Review of Clinical Pharmacology, 2021
Bernardo L. Rapoport, Tim Cooksley, Douglas B. Johnson, Ronald Anderson, Vickie R. Shannon
This is a B cell chronic leukemia that usually, but not always, progresses slowly and is the most common leukemia affecting older adults in Western countries. It may also be considered a type of non-Hodgkin’s lymphoma that results from clonal proliferation in the bone marrow, secondary lymphoid organs and blood of mature B cells that have varying levels of CD5 expression [17]. It has been reported that these CLL-B cells appear programmed to differentiate into IgM-secreting plasma cells with limited capacity for isotype switching [17,18]. This defect in B cell function may result, at least in part, from attenuation of T cell help due to immunosenescence and over-expression of inhibitory immune checkpoint molecules [19,20]. These abnormalities result in a high incidence of hypogammaglobulinemia and impaired responses to immunization, often necessitating Ig replacement therapy due to recurrent, often severe, infection with common bacterial pathogens, especially encapsulated bacteria [21]. In addition to hypogammaglobulinemia and T cell subset deficiency, defects in complement activity and neutrophil/monocyte function also occur in CLL patients [22]. Other hematological malignancies associated with hypogammaglobulinemia and increased frequency of often severe infection include multiple myeloma and malignant lymphoma/non-Hodgkin’s and Hodgkin’s lymphoma.
Autoantibody status in systemic sclerosis patients defines both cancer risk and survival with ANA negativity in cases with concomitant cancer having a worse survival
Published in OncoImmunology, 2019
Abdulla Watad, Dennis McGonagle, Nicola L. Bragazzi, Shmuel Tiosano, Doron Comaneshter, Yehuda Shoenfeld, Arnon D. Cohen, Howard Amital
At the multivariate logistic regression assessing risk of different cancer subtypes in SSc in comparison to controls after adjustment for age (Table 2), oesophagus cancer (OR 5.32 [95%CI 1.37-20.55], p = 0.0154), lung cancer (OR 2.12 [95%CI 1.25-3.60], p = 0.0053), vagina and vulva cancers (OR 9.85 [4.51-21.50], p < 0.0001), multiple myeloma (OR 3.03 [95%CI 1.31-7.03], p = 0.0097), myelodysplastic syndrome (OR 8.10 [95%CI 2.11-31.08], p = 0.0023), non-Hodgkin’s lymphoma (OR 2.75 [1.70-4.45], p < 0.0001), stomach cancer (OR 2.60 [95%CI 1.13-6.00], p = 0.0249), and malignancy of unknown primary (OR 4.32 [95%CI 3.16-5.91], p < 0.0001) were significantly higher. Chronic leukemia resulted, instead, associated in a borderline way (OR 2.62 [95%CI 0.99-6.96], p = 0.0530). The reported OR is referred to the overall risk of cancer regardless its period of onset (before or after SSc diagnosis).