Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Treatment
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- Long-acting G-CSF was mostly given as part of a dose dense schedule (n = 28; 67%).
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- Five patients (12%) developed grade 3–4 neutropenia (including one patient with neutropenic fever) after one to three cycles of 3-weekly chemotherapy (without G-CSF). Two of them received filgastrim during the acute episode of neutropenia and all five patients had long-acting G-CSF with the subsequent chemotherapy (without treatment delay) administrations in prevention of febrile neutropenia or dose delays.
- -
- Seven women (7%) received long-acting G-CSF following ‘high risk’ polychemotherapy for Non Hodgkin lymphoma (n = 4), Ewing sarcoma (n = 1) or ALL (n = 1).
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- Long-acting G-CSF (pegfilgastrim) was given prophylactically after the last chemotherapy before delivery in two women (5%).
3.2. Maternal Blood Results
3.3. Obstetric Outcome
3.4. Neonatal Outcome
3.5. Pediatric Outcome
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Maternal Characteristics | Median | Range |
---|---|---|
Age at diagnosis (years) | 34 | 19–47 |
BMI at booking (kg/m2) * | 25.9 | 18.3–36.9 |
Number | % | |
Ethnicity | ||
Caucasian | 32 | 76.2 |
Non-caucasian | 6 | 14.3 |
Not reported | 4 | 9.5 |
Type of malignancy | ||
Breast cancer | 35 | 83.3 |
Non Hodgkin lymphoma | 5 | 11.9 |
Ewing sarcoma | 1 | 2.4 |
Acute lymphocytic leukemia | 1 | 2.4 |
Treatment modality | ||
Chemotherapy | 28 | 66.7 |
Chemotherapy + surgery | 14 | 33.3 |
Chemotherapy | ||
Anthracycline-based | 18 | 42.9 |
Anthracycline-based with taxanes | 15 | 35.7 |
Other ** | 9 | 21.4 |
Median | Range | |
Gestational age at first chemo (weeks) | 22 | 11–36 |
Cycles of chemotherapy during pregnancy | 6 | 1–16 |
Administrations of G-CSF | 4 | 1–16 |
Number | % | |
Indication G-CSF | ||
Prophylactic in dose dense chemotherapy | 28 | 66.7 |
Propyhlactic in polychemotherapy regimen | 7 | 16.7 |
Prophylactic before delivery | 2 | 4.8 |
Following chemotherapy-induced neutropenia | 5 | 11.9 |
Type of G-CSF | ||
Pegfilgrastim | 28 | 66.7 |
Lipefilgrastim | 8 | 19.1 |
Filgrastim | 3 | 7.1 |
Not reported | 3 | 7.1 |
Maternal Blood Results | Total n * | Grade 1–2 | Grade 3–4 | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Neutropenia | 5 | 21 | 2 | 8 | 3 * | 13 |
Leukopenia * | 4 | 17 | 2 | 8 | 2 | 8 |
Thrombocytopenia | 0 | 0 | 0 | 0 | 0 | 0 |
Anemia | 16 | 67 | 14 | 58 | 2 | 8 |
Obstetric Outcomes | n | % |
---|---|---|
Live birth | 39 | 97.5 |
Still Birth | 1 | 2.5 |
Gestational age at delivery (n = 39 *) | ||
≥37 weeks (a term) | 20 | 51.3 |
<37 weeks (pre term) | 19 | 48.7 |
Onset of labor | ||
Spontaneous | 13 | 32.05 |
Induction of labor | 18 | 45.0 |
Cesarean section | 9 | 22.5 |
Emergency (fetal distress) | 2 | 22.2 |
Elective (all for obstetrical reason **) | 7 | 77.8 |
Reason induction of labor (n = 18) | ||
Obstetrical reason *** | 1 | 5.6 |
Therapy planning | 14 | 77.8 |
Deterioration of maternal condition | 2 | 11.1 |
Other | 1 | 5.6 |
Mode of delivery | ||
Vaginal delivery | 27 | 67.5 |
Assisted vaginal delivery | 2 | 5.0 |
Elective Cesarean section | 8 | 20.0 |
Emergency cesarean section | 3 | 7.5 |
Complications | ||
Maternal infection (including 1 chorioamnionitis) | 4 (1 postpartum) | 10.0 |
Gestational diabetes | 1 | 2.5 |
Preeclampsia | 1 | 2.5 |
Maternal neutropenia/leukopenia | 7 | 17.5 |
PPROM or preterm contractions | 9 | 22.5 |
Stillbirth | 1 | 2.5 |
Postpartum hemorrhage | 2 | 5.0 |
Neonatal Outcomes | Median | Range |
---|---|---|
Birth weight (grams) | 2855 | 850–3780 |
n | % | |
Customized birthweight percentile | ||
<10 | 11 | 28.2 |
11–49 | 18 | 46.1 |
50–89 | 8 | 20.5 |
>90 | 2 | 5.1 |
APGAR at 5 min | ||
4 | 1 | 2.6 |
9 | 8 | 20.5 |
10 | 29 | 74.4 |
Not reported | 1 | 2.6 |
Congenital malformation | ||
yes | 2 | 5.1 |
no | 37 | 94.8 |
Admission neonatal care unit | ||
yes | 16 | 41.0 |
no | 20 | 51.3 |
Not reported | 3 | 7.7 |
Reason admission neonatal care unit | ||
Prematurity | 13 | 81.3 |
Observation because of maternal chemotherapy | 1 | 6.3 |
Other | 2 | 12.5 |
Neonatal blood results | ||
Leukopenia * | 0 | 0 |
Neutropenia ** | 0 | 0 |
Thrombocytopenia *** | 1 | 5.8 |
Anemia **** | 2 | 10 |
Neonatal complications | ||
Hyperbilirubinemia | 2 | 5.2 |
Neonatal sepsis | 3 | 7.7 |
First degree cerebral bleeding related to prematurity | 1 | 2.6 |
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Berends, C.; Maggen, C.; Lok, C.A.R.; van Gerwen, M.; Boere, I.A.; Wolters, V.E.R.A.; Van Calsteren, K.; Segers, H.; van den Heuvel-Eibrink, M.M.; Painter, R.C.; et al. Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy. Cancers 2021, 13, 1214. https://doi.org/10.3390/cancers13061214
Berends C, Maggen C, Lok CAR, van Gerwen M, Boere IA, Wolters VERA, Van Calsteren K, Segers H, van den Heuvel-Eibrink MM, Painter RC, et al. Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy. Cancers. 2021; 13(6):1214. https://doi.org/10.3390/cancers13061214
Chicago/Turabian StyleBerends, Claudia, Charlotte Maggen, Christianne A. R. Lok, Mathilde van Gerwen, Ingrid A. Boere, Vera E. R. A. Wolters, Kristel Van Calsteren, Heidi Segers, Marry M. van den Heuvel-Eibrink, Rebecca C. Painter, and et al. 2021. "Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy" Cancers 13, no. 6: 1214. https://doi.org/10.3390/cancers13061214