Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Fetal Diagn Ther 2008;23:164–167 DOI: 10.1159/000111600 Management of Pregnancy in Adolescence Complicated by Acute Lymphoblastic Leukemia Nikolaos Papantoniou George Daskalakis Spyros Marinopoulos Eleftherios Anastasakis Spyros Mesogitis Aris Antsaklis 1st Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece ing this period [2]. Acute myeloid leukemia accounts for 60%, acute lymphoblastic leukemia (ALL) accounts for 28%, and chronic myelogenous leukemia accounts for 7% of leukemias arising in pregnancy [3]. Chronic lympho- blastic leukemia is usually a disease of patients beyond the reproductive age group. We report on a case of common ALL diagnosed in the third trimester of pregnancy in a woman without a previ- ous history, presenting with lymphadenopathy and leu- kocytosis. Case A 16-year-old primigravida presented at our hospital at 26 weeks + 3 days of gestation, with pallor, fatigability, exertion and persistent headache. These symptoms were present for !3 weeks and were attributed by the patient to the progression of pregnan- cy. She had been attending regular antenatal clinics elsewhere since early in the first trimester. There was no complication dur- ing pregnancy until that time and no patient medical or family history existed. On examination, cervical and axillary lymphade- nopathy was present. Abdominal examination revealed margin- ally palpable spleen and liver without tenderness or guarding, findings confirmed by ultrasound examination. Blood pressure measurement was 105/70 mm Hg. Chest x-ray was normal. Labo- ratory studies showed a white blood cell count of 53,000/ml, with a number of circulating blasts exceeding 40,000/ml, platelet count 135,000/ml, hemoglobin 11.0 g/dl, hematocrit 34.3%, alkaline phosphatase 400 U/l (normal range 90–260), total bilirubin 1.0 Key Words Acute lymphoblastic leukemia  Pregnancy  Chemotherapy Abstract The management of the common acute lymphoblastic leu- kemia in pregnancy has been controversial. We report a case of a 16-year-old primigravida with acute lymphoblastic leu- kemia, first presented in pregnancy, which was treated with aggressive chemotherapy protocols. Full remission of the disease was achieved. The neonate was born at 32 weeks following a cesarean section. The woman remains in com- plete remission, continuing maintenance chemotherapy, 18 months following diagnosis. The offspring did not show any abnormality in physical examinations or laboratory tests and keeps growing normally 18 months after birth. Copyright © 2007 S. Karger AG, Basel Introduction Acute leukemia is rare in pregnancy, with an incidence estimated to be 1 per 75,000 pregnancies [1]. In general it is among the most common malignant neoplasms of young women, thus adolescence increases the likelihood of a pregnant woman suffering from acute leukemia dur- Received: July 4, 2006 Accepted after revision: December 5, 2006 Published online: November 26, 2007 George Daskalakis 5 Katsarou Street GR–12351 Athens (Greece) Tel. +30 210 561 8001 or +30 6945 235 757 Fax +30 210 531 7224, E-Mail gdaskalakis@yahoo.com © 2007 S. Karger AG, Basel 1015–3837/08/0232–0164$24.50/0 Accessible online at: www.karger.com/fdt