Published on August 28, 2020
Chronic Lymphocytic Leukemia in Pregnant Women
Chronic lymphocytic leukemia (CLL) is rarely seen in people younger than 40, but as more women delay motherhood it is something to be aware of. Fortunately, CLL occurs in less than 1 in 10,000 women during pregnancy.
What is Chronic Lymphocytic Leukemia?
“CLL is a disease of white blood cells,” Dr. Nitin Jain explained in a Patient Power interview. “All of us have white blood cells, which perform a variety of functions in our body, including fighting infection. But one of the white blood cells specifically called B cells, those help make antibodies for us to fight infections.”
“In some patients, those B cells become cancerous,” Dr. Jain continued. “And many times, when they become cancerous, they start multiplying in the bone marrow, in the lymph nodes, and then many times they spill out in the blood.”
CLL cells circulating in the blood will show up in a blood test as an elevated blood count, leading to additional testing and — if the absolute lymphocyte count is greater than 5.00 — a chronic lymphocytic leukemia diagnosis.
To learn more about CLL, watch What is Chronic Lymphocytic Leukemia?
Are These Symptoms of CLL or Side Effects of Pregnancy?
A woman’s body goes through many changes during pregnancy, making cancer challenging to diagnose. Your internal organs adjust to make room for a baby. You experience intense fatigue. Your blood flow increases. Some women notice changes in their skin. Your appetite may come and go because of nausea, especially during the first trimester.
So, how do you know if you are experiencing typical pregnancy symptoms or something else?
According to the Mayo Clinic, chronic lymphocytic leukemia symptoms vary, but may include some or all of the following:
- Enlarged, but painless, lymph nodes
- Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen
- Night sweats
- Weight loss
- Frequent infections3
Talk to your doctor if you notice any unusual changes or have questions about something you are feeling. With cancer and many other diseases, early detection can lead to better outcomes.
Can CLL Be Treated During Pregnancy?
If you have been diagnosed with CLL while pregnant, you may feel overwhelmed by all of the decisions that follow. The first step is an appointment with your primary care physician to get a better understanding of what is going on.
Some patients may be able to delay chemotherapy, but patients and their medical team have to carefully weigh the risks to the baby because intensive chemotherapy during the first trimester can be dangerous to their development. Low birth weight, malformation, and mortality are all risks. In some situations, patients may face the difficult decision of whether to consider a therapeutic termination of the pregnancy.
“The decision to introduce or delay chemotherapy must be balanced against the impact on maternal and fetal survival and morbidity. Invariably, acute leukemia diagnosed in the first trimester necessitates intensive chemotherapy that is likely to induce fetal malformations,” wrote hematology consultant Dr. Dragana Milojkovic.2 “As delaying treatment in this situation is usually inappropriate, counseling with regard to termination of pregnancy is often essential.”
During the second and third trimester, safer treatment options may be available.
Some therapies, including the leukapheresis procedure (separating white cells from blood) and drugs such as rituximab (Rituxan), which goes after the CD20 antibody that depletes B cells, and chlorambucil (Leukeran) are used.
With rituximab, the risks are neural tube defects and skeletal and kidney abnormalities. Some patients have had some success with this drug, despite first-trimester exposure, but it’s hard for doctors to predict who will do well and who will be harmed. Because the prevalence of CLL is low in pregnant women, there is not enough data to demonstrate safety for large numbers of patients.
Whichever CLL treatment decision is made, Dr. Milojkovic recommends waiting at least 12 months after undergoing rituximab therapy before trying to get pregnant again.
Breast Feeding During Leukemia Treatment
Women can safely deliver a healthy baby even during a crisis like chronic lymphocytic leukemia. But what about after the baby is born? Will you be able to nurse?
If you have been diagnosed with CLL and are actively undergoing treatment, most doctors will recommend bottle feeding with formula instead of breastfeeding. This can be a gut-wrenching decision for moms who want to bond with their newborns, but there are other ways to do just that.
Skin-to-skin care, sometimes called kangaroo care, isn’t just for moms, but for dads too. Skin to skin contact is a great way for bonding to occur for both parents and, good news, it can happen outside of feeding time. Mothers are inundated with messages from society about what is best for mom and baby, but the most important thing is your health and the baby’s health. Formula can be a part of that first start.
Patient Power wants cancer patients and their care partners to have all of the information available so they can make the best decisions for themselves.
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~Lauren Evoy Davis
1Hepner A, et al. Cancer During Pregnancy: The Oncologist Overview. World J Oncol. 2019;10(1):28-34.
2Milojkovic D, Apperley. JF How I treat leukemia during pregnancy. Blood (2014) 123 (7): 974–984.
3CLL Overview. Mayo Clinic.
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