Pregnancy Complicated with Acute Leukemia: An Eight-Year Retrospective Study of Maternal and Fetal Outcomes

Background: Acute leukemia during pregnancy (P-AL) is a rare disease with limited data regarding the management and outcomes of mothers and fetuses. Methods: We retrospectively analyzed the characteristics, pregnancy outcomes and maternal and neonatal prognoses of 52 patients with P-AL admitted to the First Affiliated Hospital of Soochow University from January 2013 to December 2020. Findings: Twelve, 21, and 19 patients were diagnosed during the first, second, and third trimesters, respectively. Seventeen (32·7%) patients received chemotherapy during pregnancy (exposed cohort), while 35 (67·3%) received chemotherapy after abortion/delivery (nonexposed cohort). Twenty-six (50·0%) pregnancies ended with abortion, and 26 (50·0%) babies were born through spontaneous delivery or cesarean section. Seven (26·9%) of the 26 babies had been exposed to chemotherapeutic agents in utero. Fetuses in the exposed cohort had lower gestational ages (P=0·030) and birth weights (P=0·049). Considering the safety of the fetus, eight patients in the exposed cohort received low-dose chemotherapy. The low-dose cohort had a lower complete remission (CR) rate (P=0·015), and more patients in this group received HSCT (P=0·015) than patients in the standard cohort. Patients who delayed chemotherapy in the nonexposed cohort experienced a trend toward a higher mortality rate than patients who received timely chemotherapy (P=0·191). The CR, OS, and DFS were similar between the exposed and nonexposed cohorts. Overall, the 4-year overall survival (OS) and disease-free survival (DFS) rates were estimated at 49·1% and 57·8%, respectively. All newborns were living, without deformities, or developmental and intellectual disabilities. Interpretation: Our study indicated that fetuses exposed to chemotherapy in the uterus grown and developed healthily with full protection. Low-dose or delayed chemotherapy might decrease the efficacy and survival of patients, and individualized treatment was needed for patients with P-AL. Funding: This work was supported in part by grants from the National Natural Science Foundation of China (81730003, 81870120, 81900151, 82070187), the Natural Science Foundation of Jiangsu Province (BK20171205, BK20190176), the Social Development Project of Jiangsu Province (BE2019655), the Jiangsu Province Key R&D Program (BE2019798), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), and the National Key Research and Development Program (2017ZX09304021, 2017YFA0104500, 2019YFC0840604). Declaration of Interest: We declare no competing interests. Ethical Approval: The Ethics Committee of the First Affiliated Hospital of Soochow University approved our study.