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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of Hodgkin's disease associated with pregnancies are presented. Review of the literature failed to show that pregnancy had any deletorious effect on either the course or survival of patients with Hodgkin's disease; nor did therapeutic abortion alter the survival curves of these patients. There is only one report of Hodgkin's disease metastasizing to the products of conception. Both chemotherapy and irradiation are used to treat Hodgkin's disease, and both are potentially harmful to the growing fetus. Therefore, if therapy can be delayed without detriment to the patient, is should be postponed until after termination of the pregnancy.
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PMID:Hodgkin's disease in pregnancy. 63 9

During the past decade at Stanford University Medical Center, in an attempt to protect ovarian function in young female patients irradiated for Hodgkin's disease, oophoropexy has been performed at the time of surgical staging. When pelvic irradiation is administered, a 10-cm thick lead block is used to shield the ovaries in the midline. With this technique, two-thirds of women have retained ovarian function, and nine women who underwent oophoropexy prior to high-dose pelvic irradiation have become pregnant. Six patients have given birth to eight babies. An additional two patients have had therapeutic abortions and one, a spontaneous abortion. The minimum radiation dose to the ovaries was 350 to 400 rads in 39 to 46 days. No abnormalities have been observed in the children; no ectopic pregnancies have occurred.
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PMID:Pregnancy following oophoropexy and total nodal irradiation in women with Hodgkin's disease. 82 12

The malignant lymphomas are reviewed, and involvement of urogenital-ridge derivatives, including the reproductive organs, is summarized. Implications of therapy for pelvic lymphoma are discussed. It is shown by a retrospective analysis that Hodgkin's disease has little effect on fertility, the course of gestation, delivery or fetal wastage and that maternal death is not increased. No adverse effect of pregnancy on the symptoms or longevity of women with Hodgkin's disease can be demonstrated. Women diagnosed in pregnancy as having lymphoma should undergo therapeutic abortion so that proper staging and therapy may be given. Pregnancies over 32 to 34 weeks should be induced. Women previously treated for lymphoma may become infertile as a result of therapy. Those not infertile after therapy should avoid pregnancies since there is a potential risk of malformations and malignancies in the offspring.
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PMID:Malignant lymphoma: implications during the reproductive years and pregnancy. 97 52

A pregnant woman in the 17th week of gestation with Hodgkin's disease was treated with 50 mg Methotrexate i.v. on the 3 days preceeding therapeutic abortion. Cytogenetic studies on blood, brain, skin and lung of the fetus were performed. Slight structural aberrations such as gaps, chromatid breaks and accentric fragments were found in an average of 8,5% of the counted metaphases. The following drastic structural chromosome aberrations were found in 24,8% of all observed metaphases: 1) mitoses with stretched chromosomes, comparable with special segments (9,9%). 2) clumping of chromosomes in varying degrees (5,4%). 3) combinations of 1) and 2) (0,4%). 4) nuclear fragments (7,4%). 5) pulverized chromosomes (1,7%). Endoreduplications were found in 2%. The modal number was 46 with a rate of 50,1%, hypodiploids 46,3%, hyperdiploids and polyploids 3,6%. Karyotype: 46, XX.
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PMID:[Effects of Methotrexat on the chromosomes of a human fetus in vivo (author's transl)]. 121 66

Cryopreservation of spermatozoa before treatment is the only proven effective method available to circumvent the sterilizing effect of therapy in some patients with malignant diseases. Because of impaired sperm quality after freezing and thawing in-vitro fertilization/embryo transfer (IVF/ET) was indicated in 10 patients (12 cycles) during 1986-1990. The patient's mean age was 33.4 +/- 1.6 years. The following diagnoses were made: seminoma (1), testicular carcinoma (3), leiomyosarcoma of the prostate (1), Wegener's granulomatosis (1), non-Hodgkin's (1) and Hodgkin's lymphoma (3). When motile spermatozoa could be recovered after thawing, the total fraction of motile spermatozoa after swim-up separation ranged from 0.2 to 4.2 x 10(6) spermatozoa/ml (eight patients, nine cycles). In all these cases, insemination was performed with multiple oocytes per dish. Fertilization was achieved when swim-up recovered a mean of 1.8 +/- 0.5 x 10(6) spermatozoa/ml and when insemination was performed with at least a calculated concentration of motile spermatozoa of 1 x 10(5) spermatozoa/oocyte. The fertilization rate of preovulatory oocytes was 60%. Four patients achieved a pregnancy: two of them delivered a single healthy baby, one delivered triplet healthy babies and one had a preclinical abortion. In two patients (three cycles), no motile spermatozoa were recovered after thawing, and micromanipulation of oocytes for assisted fertilization was performed. Although fertilized oocytes were transferred, those couples did not achieve a pregnancy. Patients with lymphopathies had the best results, whilst those with testicular neoplasms had the poorest outcome, thus suggesting a poor gametogenic function in the non-affected testis. These results give hope to some patients with malignant diseases to maintain their reproductive capacity through sperm banking and IVF/ET.
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PMID:Successful fertilization and pregnancy outcome in in-vitro fertilization using cryopreserved/thawed spermatozoa from patients with malignant diseases. 155 43

This retrospective study concerns 13 patients in whom Hodgkin's disease was diagnosed during pregnancy or immediately after delivery (group I) and 12 patients with Hodgkin's disease who had one or several pregnancies while under treatment (group II). In group I, Hodgkin's disease was diagnosed in early pregnancy in 4 patients who all had therapeutic abortion: 3 remain in prolonged complete remission and 1 had a late relapse; 9 cases were diagnosed in late pregnancy or after delivery: 3 were treatment failures, 2 had a relapse and 4 remain in complete remission. In group II patients, 3 pregnancies occurred during initial chemotherapy and were interrupted; 5 pregnancies occurred during subsequent radiotherapy or (for earlier patients) maintenance chemotherapy, and 4 of them were interrupted; 9 pregnancies occurred within 2 years of completing treatment, and 7 after 2 years. Of the 12 patients in group II, only 2 had a relapse whereas 10 remain in complete remission. Although they should be interpreted with caution, these data suggest that Hodgkin's disease diagnosed in late pregnancy or after delivery might be more active, and they justify therapeutic abortion when diagnosis is made in early pregnancy. They do not indicate a high risk of relapse in treated Hodgkin's disease patients during a subsequent pregnancy, even if it occurs shortly after treatment.
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PMID:[Influence of pregnancy on the development of Hodgkin's disease]. 296 82

To evaluate the potential teratogenicity and mutagenicity of modern cancer treatment, the authors enumerated from a cooperative clinical trial group 133 pregnancies in 66 women with malignant neoplasms (53% with Hodgkin's disease, 26% with other lymphomas and leukemia, and 21% with solid tumors). The gestations were divided into the following groups: Group 1, 43 pregnancies ending before therapy; Group 2, therapy given at conception or during 32 pregnancies; and Group 3, 58 pregnancies after therapy. Although the total frequencies of abnormalities were similar in Groups 1 and 2 (23% of 35 pregnancies not electively aborted and 28% of 25, respectively), there were slightly more elective abortions and birth defects related to radiation exposure at a susceptible time of gestation in Group 2. Still, there were eight normal infants among the ten fetuses who were liveborn and had first trimester exposure to chemotherapy alone; so, drug therapy early in pregnancy is not inevitably teratogenic. The apparent and surprising excess of abnormal outcomes in Group 3, 40% of 50 pregnancies, was due to low birth weight and premature terminations of pregnancy, rather than an excess of congenital anomalies. The type of unfavorable outcomes in Group 3 and their concentration in the first year posttherapy suggested they could represent defects in factors (e.g., uterine or hormonal) that normally maintain gestations, and not genetic damage to oocytes. Limitations of the data, collected by mail from physicians and their patients, included biases of self-reporting and low statistical power. Prospective study, probably through interinstitutional collaboration, seems necessary, if accurate estimates are to be made of the frequency of certain outcomes, such as spontaneous abortion and minor anomalies.
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PMID:Pregnancy outcome in cancer patients. Experience in a large cooperative group. 360 30

16 young women in long-term remission after first-line treatment for the early stages of Hodgkin's disease were examined for ovarian function 48 to 125 months after termination of therapy. The patients had received mantle field irradiation, plus either irradiation of infradiaphragmatic lymph nodes or 6 cycles of MOPP. 4 patients showed signs of ovarian failure judged by menopausal symptoms, menstrual pattern and/or hormone values. 12 patients had functioning ovaries; 8 of these had become pregnant after treatment, 2 had had an induced abortion, and 7 had given birth to a total of 9 healthy babies after treatment. The patients with signs of ovarian failure were older than the others, but the difference was not statistically significant. No difference between the patients who had received different treatments was established, nor does the study confirm the proposed protective effect of oral contraceptives. For women under 35 years of age, the long-term chances of preserving ovarian function after standard treatment for the lower stages of Hodgkin's disease seem to be much better than hitherto assumed.
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PMID:Ovarian function in young women in long-term remission after treatment for Hodgkin's disease stage I or II. 642 41

Fifteen pregnant women with Hodgkin's disease were followed. Five patients had irradiation, 1000 to 3000 rad to the neck, mediastinum, or both, during the second or third trimester with normal outcome of pregnancy. One patient had a spontaneous abortion in the first trimester after radiotherapy of 4400 rad to the breast, an estimated fetal dose of 9 rad. One patient who received chlorambucil throughout pregnancy delivered a normal infant. Six patients had therapeutic abortions; one had early induction of labor. In one patient previously treated for supradiaphragmatic Hodgkin's disease, detection of a supradiaphragmatic relapse was delayed because of pregnancy. We recommend abortion for patients who develop Hodgkin's disease early in pregnancy or who have received chemotherapy or irradiation during the first trimester. During the latter half of pregnancy, asymptomatic disease may be closely followed but early delivery is recommended. Supradiaphragmatic, symptomatic disease can be treated with modified irradiation. For subdiaphragmatic, symptomatic, or extranodal disease, single-agent chemotherapy may be preferable. Treatment requires individualization to insure that the patient will be cured and the fetus protected.
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PMID:Management of the pregnant patient with Hodgkin's disease. 730 42

Hematologic neoplasms diagnosed during pregnancy, present significant difficulties in patient management. Besides the strictly medical facts, moral, ethical and religious issues should be strongly considered. For the optimal management of individual situations an integrated multidisciplinary approach is mandatory. Hodgkin's disease, acute leukemias, non Hodgkin's lymphoma and less frequently chronic myelogenous leukemia have been reported in pregnant women. Curative treatment for most of these diseases include intensive chemotherapy regimens. Potential damage to the fetus is a major concern, due to the teratogenic effects of antimetabolites, alkylating agents and radiation therapy. Effect of pregnancy in each of these neoplasms is discussed. Although some rules of management exist, dangerous generalizations should be avoided. Particular obstetric considerations such as timing of delivery, and therapeutic abortion should be carried out on an individual basis. The emotional impact of the situation must not be underestimated.
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PMID:[Hematologic neoplasms and pregnancy]. 756 54


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