Continuing dilemmas in the management of lymphoma during pregnancy: review of a 10-point case-based questionnaire.

INTRODUCTION: Due to the rarity of lymphoma during pregnancy, management guidelines are based upon evidence from retrospective studies and case reports. Here, we review the major dilemmas in the field and examine the approach of hemato-oncologists in Israel to the management of lymphoma in pregnancy.

METHODOLOGY: We performed a literature search on the PubMed database using keywords for all papers on the subject from 1990-2014. The papers were reviewed by an expert panel who devised a questionnaire covering the main dilemmas. Sixty questionnaires were sent out.

RESULTS: Non-contrast magnetic resonance imaging was the staging modality of choice. Chemoimmunotherapy was considered relatively safe beyond the first trimester except methotrexate (completed postpartum). Steroids or vinblastine were suggested by most as a reasonable 'bridging therapy' until the second trimester in Hodgkin lymphoma. The dosage of chemoimmunotherapy employed during pregnancy remained debatable; the majority recommended dosage according to actual pregnancy weight. Optimal timing for delivery was considered by most to be >35 weeks. Regarding approach to next pregnancy for patients in complete remission from diffuse large B-cell lymphoma, 69 % advised waiting 2 years but the majority advised 6-12 months for follicular lymphoma.

DISCUSSION: Despite consensus regarding the safety of chemotherapy post first trimester, optimal dosage, central nervous system therapy, timing of delivery and approach to future pregnancies remain controversial, indicating a need for further collaborative research in this field.