Management of acute myeloid leukemia during pregnancy and after birth: a report of two cases

The present study was to report the management of two cases of successful mother and fetal outcome of acute myeloid leukemia (AML) during pregnancy and after birth. Both patients were diagnosed with AML in their third trimesters of pregnancy. They have normal karyotype. The fusion gene of AML/ETO for case 1 was negative and of CBFB/MYH11 for case 2. Then they received combination chemotherapy (daunorubicin plus cytarabine) during pregnancy and both of them were in remission. They successfully delivered a normal infant at 35 weeks and 37 weeks of gestation and prepared for allogeneic hematopoietic stem cell transplantation (Allo-HSCT). The peripheral blood stem cells for case 1 were provided by Chinese bone marrow bank with an HLA-match of 5.5/6 and for case 2 were by her brother with an identical HLA-match. Then they received conditioning regimen of busulfan and cyclophosphamide, and Graft-versus-Host Disease prophylaxisof cyclosporine A in combination with short-course methotrexate before Allo-HSCT. Both of them received successful bone marrow transplantation and achieved hematopoietic recovery after Allo-HSCT. No serious manifestations of acute graft-versus-host disease were found in them. They were both survived and resumed to a normal life and work, with respective survival time of 81 months and 62 months at recent follow-up. The two male infants were survived and grew up with normal development. Rapid diagnosis and immediate treatment for pregnant patients with AML in the third trimesters can provide more successful opportunities for Allo-HSCT, and also may be beneficial for the survival of both mothers and fetuses.