4
Karin's
Chemotherapy

Karin commences chemotherapy

Karin consents to a modified chemotherapy regimen.

Despite the limited data available on the safety of chemotherapy dosing in pregnancy, Karin continues to be concerned about potential risks to her baby. After discussions between Karin, the haematologist, and the maternal fetal medicine specialist, Karin consents to only partial dosing of her chemotherapy treatments because of the concern for the developing fetus. Two drugs are omitted from the regimen based on the perceived risks to the fetus of these particular drugs.

At 28 weeks Karin has completed her initial course of chemotherapy and has a bone marrow biopsy to assess her response. Unfortunately, she has not attained a complete haematological remission and there are still blasts in her bone marrow. The Haematologist advises that her baby should be delivered as soon as possible in order for her to receive more intensive chemotherapy (at higher doses) to achieve remission before embarking on a bone marrow transplant.

A multidisciplinary meeting is held with Karin, Peter, the haematologist, the MFM specialist, the obstetrician, the midwife and the Neonatologist. The following options are discussed:

  1. Increase chemotherapy at 29 weeks and aim for one more three week chemotherapy cycle. Delivery would then be planned at around 33/34 weeks gestation to allow for some bone marrow recovery after the chemotherapy.
  2. Deliver at 30 weeks and commence the high dose chemotherapy the following week (at 31 weeks)
  3. Deliver in two weeks at 31 weeks gestation

Karin’s Delivery Options

Karin considers some advice from specialists.

Which option would you recommend to Karin?

Start full dose chemotherapy immediately and deliver around 33/34 weeks – the option favoured by the MFM specialist

Deliver as soon as possible then start full dose chemotherapy – the option favoured by Peter and the haematologist

Delay chemotherapy for three weeks, deliver at 31 weeks then start full dose chemotherapy - the option favoured by the neonatologist, the obstetrician and the midwife

In the following videos Dr Daniel Challis, Obstetrician and Gynaecologist discusses how to consider the increasing interests of the fetus as pregnancy progresses and Dr Debra Kennedy, Geneticist and Maternal Fetal Medicine Specialist from the Royal Hospital for Women discusses how clinicians deal with treatment choices where there is an absence of clinical data to inform decision making.

Dr Daniel Challis

“In the context of pregnancy, how should we consider the gradually increasing interests of the maturing fetus?”

Dr Debra Kennedy

“What if there is no or minimal pharmacokinetic data to inform appropriate treatment choice?”

Karin is referred to the maternal fetal medicine team
KARIN'S OUTCOME