Stillbirth in week 19 of pregnancy followed by maternal death as a consequence of refused chemotherapy for non-hodgkin's lymphoma--significance of adjuvant chemotherapy in women of reproductive age

Evelyn Hauenstein; Stefan Seidl; Karl T M Schneider; Thorsten Fischer

doi:10.1159/000322213

Stillbirth in week 19 of pregnancy followed by maternal death as a consequence of refused chemotherapy for non-hodgkin's lymphoma--significance of adjuvant chemotherapy in women of reproductive age

Onkologie. 2010;33(12):692-4. doi: 10.1159/000322213. Epub 2010 Nov 26.

Authors

Evelyn Hauenstein¹, Stefan Seidl, Karl T M Schneider, Thorsten Fischer

Affiliation

¹ Department of Obstetrics and Gynecology, Technical University of Munich, Germany. evelyn.hauenstein@web.de

PMID: 21124040
DOI: 10.1159/000322213

Abstract

Background: Due to rising cure rates in cancer, the question of preserving fertility in young female patients becomes more important. Especially in lymphomas, incidence and long-time survival have increased. Hematologists and gynecologists have to treat more and more female patients who wish to become pregnant despite their disease and/or after finishing treatment.

Case report: We report on a 28-year-old patient with highly malignant non-Hodgkin's lymphoma (peripheral T cell lymphoma, Ann Arbor stage IV) and main manifestation at the gastric antrum, with a distinct wish for becoming pregnant. Chemotherapy was strongly recommended to her, but she refused. After she had conceived, the disease recurred, followed by stillbirth in week 19 of gestation and death due to gastric perforation and septic shock.

Conclusions: Facing the risk of sterility after chemotherapy should not induce patients to refuse chemotherapy and risk their lives. Treatment of young female cancer patients should therefore always include a thorough discussion about other ways of preserving fertility for the time after treatment. Such strategies exist, although their success is still limited and not every patient is eligible for them.

Publication types

Case Reports

MeSH terms

Adult
Antineoplastic Combined Chemotherapy Protocols / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Antineoplastic Combined Chemotherapy Protocols / toxicity*
Chemotherapy, Adjuvant / adverse effects
Cyclophosphamide / administration & dosage
Cyclophosphamide / toxicity
Doxorubicin / administration & dosage
Doxorubicin / toxicity
Fatal Outcome
Female
Gastrectomy
Humans
Infertility, Female / chemically induced*
Infertility, Female / prevention & control
Lymphoma, T-Cell, Peripheral / drug therapy*
Lymphoma, T-Cell, Peripheral / pathology
Lymphoma, T-Cell, Peripheral / surgery*
Neoplasm Recurrence, Local / pathology
Neoplasm Staging
Prednisone / administration & dosage
Prednisone / toxicity
Pregnancy
Pregnancy Complications, Neoplastic / drug therapy*
Pregnancy Complications, Neoplastic / pathology
Pregnancy Complications, Neoplastic / surgery*
Pregnancy Trimester, Second
Pyloric Antrum / pathology
Rupture, Spontaneous
Shock, Septic / pathology
Stillbirth*
Stomach Neoplasms / drug therapy*
Stomach Neoplasms / pathology
Stomach Neoplasms / surgery*
Stomach Rupture / parasitology
Treatment Refusal*
Vincristine / administration & dosage
Vincristine / toxicity

Substances

Vincristine
Doxorubicin
Cyclophosphamide
Prednisone

Supplementary concepts

CHOP protocol