Multiple myeloma during pregnancy as a challenge in clinical practice – a review

Magdalena Szydełko, Joanna Szydełko, Michał Litwińczuk

Abstract


Introduction: Multiple myeloma (MM) is a hematological malignancy characterized by an abnormal proliferation and accumulation of monoclonal plasma cells. MM typically affects the elderly people with the median age at the diagnosis between 65 to 74 years. Only in < 2% of cases it is observed <40 years, that is why its incidence in gestation is extraordinary.
Aim of the study: The aim of this study was to present the review of the literature concerning the cases of MM in pregnancy as a great challenge in clinical practice. Moreover, the most common symptoms, diagnostic as well as therapeutic strategies of MM in pregnancy were discussed. The influence of the status of the newborns and the pregnant women were also analyzed.
Description of knowledge: Our overview revealed 44 cases of MM in pregnancy. It was predominantly diagnosed in the 2nd or 3rd trimester and the median age of women was 34 years. The caesarean section seemed to be the recommended method of delivery and the mean gestational age at the delivery was 35. hbd. Nearly all of the newborns were born premature, but healthy. The symptoms were similar to those in the general population (bone pain, signs of anemia, hypercalcemia) and in single cases the renal failure, hypertensive or bilateral breast lumps were observed. Steroids were predominantly administered and the therapy based on cyclophosphamide, urethane or interferon was the rarity.
Conclusions: MM in pregnancy seems not be a contraindication for maintaining of gestation. The management may be problematic due to the lack of guidelines concerning the methods of treatment as well as its safety for the fetus. Based on the literature, steroids are the most certain and efficient anti-MM drugs in pregnancy. However, the majority of newborns are premature, which is also associated with the possibility of later complications.

Keywords


multiple myeloma; pregnancy; symptoms; diagnosis; therapeutic strategies

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References


Mahmoud HK, Samra MA, Fathy GM. Hematologic malignancies during pregnancy: A review. J Adv Res. 2016; 7(4):589-596. doi: 10.1016/j.jare.2016.02.001.

Lavi N, Horowitz NA, Brenner B. An update on the management of hematologic malignancies in pregnancy. Womens Health (Lond). 2014; 10(3):255-2566. doi: 10.2217/whe.14.17.

Kasenda B, Rückert A, Farthmann J, Schilling G, Schnerch D, Prömpeler H, et al. Management of multiple myeloma in pregnancy: strategies for a rare challenge. Clin Lymphoma Myeloma Leuk. 2011; 11(2):190-197. doi: 10.1016/j.clml.2011.03.009.

Jurczyszyn A, Olszewska-Szopa M, Vesole AS, Vesole DH, Siegel DS, Richardson PG, et al. Multiple Myeloma in Pregnancy--A Review of the Literature and a Case Series. Clin Lymphoma Myeloma Leuk. 2016;16(3):e39-45. doi: 10.1016/j.clml.2015.11.020.

Borja de Mozota D, Kadhel P, Dermeche S, Multigner L, Janky E. Multiple myeloma and pregnancy: a case report and literature review. Arch Gynecol Obstet. 2011; 284(4):945-950. doi: 10.1007/s00404-011-1985-8.

Kumar SK, Callander NS, Alsina M, Atanackovic D, Biermann JS, Chandler JC, et al. Multiple Myeloma, Version 3.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2017; 15(2):230-269.

Giordano C. [Multiple myeloma and pregnancy. (1st case in the world literature)]. Matern Infanc (Sao Paulo). 1965; 24(2):158-184.

Kim MJ, Kim JH, Kim IY, Lee SB, Park IS, Han MY, et al. Light Chain Deposition Disease Associated With Multiple Myeloma Developing in Late Pregnancy. Iran J Kidney Dis. 2018; 12(2):132-134.

Avilés A, Neri N. Multiple myeloma and pregnancy. Am J Hematol. 2011; 86(1):81-82. doi: 10.1002/ajh.21876.

Rajkumar SV. Multiple myeloma. Curr Probl Cancer. 2009; 33(1):7-64. doi: 10.1016/j.currproblcancer.2009.01.001.

Brisou G, Bouafia-Sauvy F, Karlin L, Lebras L, Salles G, Coiffier B, et al. Pregnancy and multiple myeloma are not antinomic. Leuk Lymphoma. 2013; 54(12):2738-2741. doi: 10.3109/10428194.2013.786069.

Cabañas-Perianes V, Macizo M, Salido E, Blanquer M, Araico F, Melero-Amor A, et al. 'Management multiple myeloma during pregnancy: a case report and review'. Hematol Oncol. 2016; 34(2):108-114. doi: 10.1002/hon.2184.

Quinn J, Rabin N, Rodriguez-Justo M, Choi D, Yong K. Multiple myeloma presenting with spinal cord compression during pregnancy. Ann Hematol. 2009; 88(2):181-182. doi: 10.1007/s00277-008-0558-9.

Smith D, Stevens J, Quinn J, Cavenagh J, Ingram W, Yong K. Myeloma presenting during pregnancy. Hematol Oncol. 2014; 32(1):52-55. doi: 10.1002/hon.2088.

Zun KH, Choi HM. Multiple myeloma presenting as vertebral compression during pregnancy. Int J Gynaecol Obstet. 2008; 100(1):89-90. doi: 10.1016/j.ijgo.2007.05.041.

Khot AS, Prince HM, Harrison SJ, Seymour JF. Myeloma and pregnancy: strange bedfellows? Leuk Lymphoma. 2014; 55(4):966-968. doi: 10.3109/10428194.2013.837163.

Forthman CL, Ponce BA, Mankin HJ. Multiple myeloma with a pathologic fracture during pregnancy. A case report. J Bone Joint Surg Am. 2004; 86(6):1284-1288. doi: 10.2106/00004623-200406000-00024.

McIntosh J, Lauer J, Gunatilake R, Knudtson E. Multiple myeloma presenting as hypercalcemic pancreatitis during pregnancy. Obstet Gynecol. 2014; 124(2 Pt 2 Suppl 1):461-463. doi: 10.1097/AOG.0000000000000361.

Lee JC, Francis RS, Smith S, Lee R, Bingham C. Renal failure complicating myeloma in pregnancy. Nephrol Dial Transplant. 2007; 22(12):3652-3655. doi: 10.1093/ndt/gfm277.

Dabrowska DM, Gore C, Griffiths S, Mudzingwa M, Varaday S. Anaesthetic management of a pregnant patient with multiple myeloma. Int J Obstet Anesth. 2010; 19(3):336-339. doi: 10.1016/j.ijoa.2010.03.010.

Bouzguenda R, Khanfir A, Toumi N, Chaaben K, Hentati Y, Ayadi L, et al. Multiple myeloma presenting as bilateral breast lumps in pregnant woman. Int J Hematol. 2013; 98(4):487-490. doi: 10.1007/s12185-013-1420-y.

American College of Obstetricians and Gynecologists' Committee on Obstetric Practice. Committee Opinion No. 656: Guidelines for Diagnostic Imaging During Pregnancy and Lactation. Obstet Gynecol. 2016; 127(2):e75-80. doi: 10.1097/AOG.0000000000001316.

ACR practice guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. 2008.

Lergier JE, Jiménez E, Maldonado N, Veray F. Normal pregnancy in multiple myeloma treated with cyclophosphamide. Cancer. 1974; 34(4):1018-1022. doi: 10.1002/1097-0142(197410)34:4<1018::aid-cncr2820340409>3.0.co;2-4.

Sakata H, Karamitsos J, Kundaria B, DiSaia PJ. Case report of interferon alfa therapy for multiple myeloma during pregnancy. Am J Obstet Gynecol. 1995; 172(1 Pt 1):217-219. doi: 10.1016/0002-9378(95)90120-5.

Kosova LA, Schwartz SO. Multiple myeloma and normal pregnancy. Report of a case. Blood. 1966; 28(1):102-111.

Rosner F, Soong BC, Krim M, Miller SP. Normal pregnancy in a patient with multiple myeloma. Obstet Gynecol. 1968; 31(6):811-820.

Talerman A, Serjeant GR, Milner PF. Normal pregnancy in a patient with multiple myeloma and sickle cell anaemia. West Indian Med J. 1971; 20(2):97-100.

Talerman A. Successful pregnancy in patients with multiple myeloma. Arch Pathol Lab Med. 1987; 111(10):895-896.

Harster GA, Krause JR. Multiple myeloma in two young postpartum women. Arch Pathol Lab Med. 1987; 111(1):38-42.

Malee MP. Multiple myeloma in pregnancy: a case report. Obstet Gynecol. 1990; 75(3 Pt 2):513-515.

Caudle MR, Dodd S, Solomon A. Multiple myeloma in pregnancy: a case report. Obstet Gynecol. 1990; 75(3 Pt 2):516-518.

Pajor A, Kelemen E, Mohos Z, Hambach J, Váradi G. Multiple myeloma in pregnancy. Int J Gynaecol Obstet. 1991; 35(4):341-342. doi: 10.1016/0020-7292(91)90669-v.

Maglione A, Di Giorgio G, Petruzzelli F, Longo MP. Multiple myeloma diagnosed during early pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol. 2003; 111(2):214-215. doi: 10.1016/s0301-2115(03)00217-3.

Malik S, Oliver R, Odejinmi F. A rare association with hyperemesis: pregnancy and multiple myeloma. J Obstet Gynaecol. 2006; 26(7):693-695. doi: 10.1080/01443610600929961.

Wilmott F, Agarwal N, Heath M, Stevens J, Chakravatti S. Plasma cell myeloma diagnosed in pregnancy. BMJ Case Rep 2010, 2010. doi: 10.1136/bcr.04.2010.2901

Rodríguez LGR, Lianes OA, Padrón CH, Martínez EE. The multiple myeloma and the pregnancy: First case report in Cuba. Rev Cuba Hematol Immunol Hemoter 2010; 26:70-75.

Reinhard G, Noll A, Schlebusch H, Mallmann P, Ruecker AV. Shifts in the TH1/TH2 balance during human pregnancy correlate with apoptotic changes. Biochem Biophys Res Commun. 1998; 245(3):933-938. doi: 10.1006/bbrc.1998.8549.




DOI: http://dx.doi.org/10.5281/zenodo.3408437

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