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BMC Pregnancy and Childbirth

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01-12-2020 | Pharmacokinetics | Case report

Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report

Authors: Camille Cotteret, Yen-Vi Pham, Ambroise Marcais, Marine Driessen, Salvatore Cisternino, Joël Schlatter

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

Hodgkin lymphoma (HL) is the most common hematological malignancy during pregnancy. The first-line treatment for HL in pregnancy is the standard ABVD regimen without any drug and/or dose adjustment. However, data on chemotherapy during twin pregnancies are sparse, and a better understanding of the mechanisms involved in exposure to and the toxic effects of anticancer drugs in the fetuses is needed.

Case presentation

A 41-year-old dichorionic diamniotic pregnant patient was given ABVD treatment for HL at a gestational age of 28 weeks and 3 days. The patient received 2 cycles of chemotherapy with a 15-day therapeutic window including an actual 25 mg/m² dose of doxorubicin per cycle. Unlike the female twin, the male twin presented four days after birth a left cardiac dysfunction. Doxorubicin cardiotoxicity in the male newborn was also supported by high blood levels of troponin. At one month of age, echocardiography findings were normal. We investigated literature data on physiological aspects of pregnancy that may influence doxorubicin pharmacokinetics, and pharmacodynamic and pharmacokinetic data on the use of doxorubicin in pregnancy. We detailed the role of the transporters in doxorubicin placenta distribution, and tried to understand why only one fetus was affected.

Conclusions

Fetal safety depends at least on maternal doxorubicin pharmacokinetics.Because of drug interactions (i.e. drug metabolism and drug transport), care should always be taken to avoid maternal pharmacokinetic variability. The toxic effects were discrepant between the dizygotic twins, suggesting additional fetus-specific pharmacokinetic/pharmacodynamic factors in doxorubicin toxicity.

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Title: Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report
Authors: Camille Cotteret
Yen-Vi Pham
Ambroise Marcais
Marine Driessen
Salvatore Cisternino
Joël Schlatter
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Pharmacokinetics
Hodgkin Lymphoma
Cytostatic Therapy
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-02928-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Maternal ABVD chemotherapy for Hodgkin lymphoma in a dichorionic diamniotic pregnancy: a case report

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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