Background: Acute myeloid leukemia (AML) accounts for more than two thirds of leukemia during pregnancy and
has an incidence of 1 in 75,000 to 100,000. Its clinical management remains a challenging therapeutic task both for
patient and medical team, given to the therapy-attributable risks for mother and fetus and the connected
counseling regarding pregnancy continuation.
Methods: We provided a review of updated literature and a comprehensive description of five maternal/fetal
outcomes of AML cases diagnosed concomitantly to pregnancy and treated at our Institution from 2006 to 2012.
Results: Median age at AML diagnosis was 32 years (31–39). One diagnosis was performed in first trimester and the
patient asked for therapeutic abortion before starting chemotherapy. Three cases were diagnosed in second/third
trimester; in one case leukemia was diagnosed concomitantly with intrauterine fetal death, while the remaining two
patients continued pregnancy and delivered a healthy baby by cesarean section. In only one of these two cases
chemotherapy was performed during pregnancy (at 24 + 5 weeks) and consisted of a combination of
daunorubicine and cytarabine. Therapy was well tolerated and daily fetus monitoring was performed. After
completion of 30 weeks of gestation a cesarean section was carried out; the newborn had an Apgar score of 5/1'-
7/5'-9/10', oxygen therapy was temporarily given and peripheral counts displayed transient mild leukopenia. One
patient had diagnosis of myelodysplastic syndrome rapidly progressed to AML after delivery. Four out of the 5
described women are currently alive and disease-free. Three children were born and long-term follow-up has
shown normal growth and development.
Conclusions: The treatment of AML occurring during pregnancy is challenging and therapeutic decisions should
be taken individually for each patient. Consideration must be given both to the immediate health of mother and
fetus and to long-term infant health. Our series confirmed the literature data: fetal toxicity of cytostatic therapy
clusters during the first trimester; while chemotherapy can be administered safely during second/third trimester and
combination of daunorubicin and cytarabine is recommended for induction.
Keywords: Acute myeloid leukemia, Pregnancy, Chemotherapy
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