A new set of guidelines has been developed to help diagnose and manage serious blood cancers in pregnancy.
About 12.5 pregnancies per 100,000 are affected by blood cancers, such as acute leukemia and aggressive lymphomas, and their incidence is increasing.
Between 1994 and 2013, they increased by 2.7 percent annually, due to factors such as women having children later, improved diagnostic techniques and increased engagement in the health system.
An Australian working group has now published a new position statement in its latest version THE Lancet Hematologybased on current evidence and expert consensus.
It is a practical guide for physicians, including recommendations for diagnosis and staging, safety of imaging in pregnancy, treatment in pregnancy incorporating a multidisciplinary approach, supportive care, oncology and management of pregnancy and birth.
Lead author Dr. Georgia Mills from Macquarie Medical School says a cancer diagnosis in pregnancy is incredibly distressing for a patient and her family.
In addition, however, women may face delays in treatment, inaccurate information and communication breakdowns, which increase the anxiety associated with a cancer diagnosis and fears for their unborn baby.
Patients have also described a lack of sensitivity about fertility preservation, breastfeeding, the risks of medication to the unborn baby, and a lack of information and support groups.
We want women and their babies to experience the best possible health outcomes, not delayed or denied care.”
Dr. Georgia Mills, Macquarie School of Medicine
Senior author Dr. Gisele Kidson-Gerber says that taking an interdisciplinary approach was paramount in preparing the guidelines.
“Blood cancers in pregnancy present unique therapeutic challenges, yet there were no clinical guidelines for diagnosis or management,” she says.
“As clinicians, we must balance the need for optimal treatment for the mother with the safety and well-being of the unborn child.
“Most treatments are possible during pregnancy, including many forms of chemotherapy, but this is not what patients expect.”
The guidelines were drafted using co-design principles, with a patient representative on the working group to ensure that patient concerns were well understood.
Victoria Bilsland was diagnosed with stage 4B nodular Hodgkins lymphoma when she was 17 weeks pregnant.
But with her symptoms repeatedly dismissed as pregnancy pain or a possible infection, just getting a diagnosis was a struggle that led her to lose faith in doctors.
“I was told ‘I needed spinal surgery’ and to ‘consider termination’, and when I refused termination as we didn’t yet know the extent of the cancer, they advised me to ‘think logically,'” she says.
“I was offered to terminate my pregnancy on several occasions, but I had no information about the risks to me or my baby, what stage the cancer was or even where it was.
“How could I make an impossible decision without information? And why couldn’t anyone give me information about cancer and pregnancy?
“The process was a rollercoaster of trauma, depression and anxiety.”
She was eventually placed under the care of a team of specialists experienced in the management of haematological cancers in pregnancy, received appropriate treatment and gave birth to a healthy son at 32 weeks.
He hopes the new guidelines will help other doctors make the same decision early, putting the patient first and reducing potential trauma.
The guidelines have been approved by the councils of the Society of Obstetrics and Gynecology of Australia and New Zealand and the Society of Hematology of Australia and New Zealand.
Source:
Journal Reference:
Mylos, G.et al. (2025) Position statement on the diagnosis and management of acute leukemia and aggressive lymphomas in pregnancy. The Lancet Hematology.
