what about long-term survival?

A team of Parisian researchers assessed the incidence of hematologic malignancies occurring during pregnancy in France in a study called HEMAPREG. They show that pregnancy does not lead to a loss of chance in terms of survival. The study was published in The Lancet Hematology . Presentation of the results by the Dr Rudy Birsen, hematologist at Cochin Hospital in Paris (AP-HP) and co-author of the study.

A much more complete study

Based on a national cohort from the National Health Data System (SNDS), the HEMAPREG study aimed to evaluate the incidence of hematologic malignancies occurring during pregnancy in France, and to analyze maternal and obstetric complications. and to obtain robust epidemiological data to better guide medical practices.

“Previously, we only had trials with small cohorts. Our study concerns epidemiological data on the entire French population, which is much more complete,” underlines the Dr Rudy Birseninterviewed by Medscape.

The study included all women in France whose pregnancies ended between 1^is January 2012 and December 31, 2022. Pregnancies ending in miscarriage or voluntary termination of pregnancy whose care was not hospitalized, as well as women with a history of hematological malignancies before pregnancy, were excluded.

1,366 hematological cancers associated with pregnancy in 10 ans

The results made it possible to count 1,366 cases of hematological cancers associated with pregnancy between 2012 and 2022, in France, out of a total of 9,996,523 pregnancies, i.e. a frequency of 13.66 per 100,000 pregnancies. A refinement of the data showed that, among these cases, 413 were diagnosed during pregnancy, with a frequency of 4.13 per 100,000 pregnancies, and 953 cases in the year following pregnancy, or 9.53 per 100,000 pregnancies. 100,000 pregnancies​.

“We also asked ourselves the question: does being pregnant at the time of diagnosis confer a worse prognosis? », continues Dr Birsen. The answer is no: women with hematologic malignancies during pregnancy had the same probability of long-term survival as women with hematologic malignancies who were not pregnant. “Survival is very good for most hematologic malignancies, even if acute leukemia is more serious than Hodgkin’s lymphoma, for example. In any case, pregnancy did not lead to a loss of chance in terms of survival,” explains Dr. Birsen.

Many patients give birth prematurely due to treatment constraints and the disease can also cause premature births.
Dr Birsen

More maternal complications

However, a comprehensive analysis showed that these patients had more maternal complications. “They have more infections, bleeding, transfusions or visits to intensive care but this is more linked to their blood disease than to their pregnancy,” he believes.

A higher risk of prematurity was also highlighted (45.2%) compared to women without hemopathy (6.6%).

“Many patients give birth prematurely due to treatment constraints and the disease can also cause premature births,” he notes.

Care must be multidisciplinary with very specialized centers
Dr Birsen

Furthermore, medical terminations of pregnancy are frequently observed during the first trimester of pregnancy, due to the risk of malformation linked to chemotherapy treatment. “From 2^e et 3^e trimesters, the risk of malformation almost disappears. However, uncertainty persists regarding neurodevelopmental disorders for certain exposures,” comments the doctor.

For him, these results are important to better care for patients. “The care must be multidisciplinary with very specialized centers,” he insists.

A second study, on the outcome of the children, will determine whether they had complications during the neonatal period, with follow-up over several years.

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