Finding out that you or your partner have lymphoma can bring extremely challenging feelings. When the diagnosis comes during pregnancy, it can add significantly to your distress. Your thoughts may turn to your baby’s safety during diagnostic tests and scans. You may be concerned about whether treatment will affect them immediately or in the long-term.
Knowing a bit about how lymphoma is treated during pregnancy can help you to feel calmer and more in control. The information on this page can guide you in asking questions of your medical team and help you make decisions about your care and treatment.
A diagnosis of lymphoma during pregnancy is quite rare; around 1 in 1,000 pregnant women are diagnosed with lymphoma.
Hodgkin lymphoma can occur at any age; however, it most commonly affects people between the ages of 15 and 34 (key childbearing years), and those over 60. Hodgkin lymphoma is more common in pregnant women compared with non-Hodgkin lymphoma (NHL).
The risk of developing NHL increases with age. Most people diagnosed are over 55. When it is diagnosed in pregnancy, NHL tends to be a fast-growing type such as diffuse large B-cell (DLBCL) or peripheral T-cell lymphoma. The fact that the lymphoma is fast-growing does not impact on the overall prognosis (outlook).
Low-grade NHL (LGNHL) is slow-growing; a diagnosis of LGNHL during pregnancy is rare.
Some of the typical symptoms of pregnancy (eg anaemia, thrombocytopenia, fatigue and aches) are similar to possible signs of lymphoma. This can delay diagnosis. However, it does not seem that pregnant women are diagnosed with a later stage lymphoma than those who are not pregnant when they are diagnosed.
A biopsy (sample of tissue looked at to check for abnormal cells) is usually needed to confirm a diagnosis of lymphoma. A biopsy is done while you are under local or general anaesthetic. Neither the anaesthetic nor the test should be harmful to your unborn child.
Once you have had a biopsy, doctors do staging tests to see which parts of your body contain lymphoma. Staging often involves X-rays, CT scans or PET scans, which use radiation. The levels of radiation are generally low enough not to cause harm to your baby. Nonetheless, your doctor may prefer to do an MRI scan or an ultrasound scan, neither of which use any radiation.
Note: If you have a PET scan, you are slightly radioactive for a few hours afterwards. It’s advised that you avoid close contact with your baby and breast feeding during this time. Breast feeding after a CT scan is safe.
Your health is the priority for your medical team. Their goal is to cure you of lymphoma or to limit its growth for as long as possible. Your medical team also consider your baby’s safety while still in the womb and after birth.
Your treatment plan depends on several factors, including:
- the type of lymphoma you have, where it is and how fast it is growing
- which trimester of your pregnancy you are in
- your personal wishes.
Most of the time, doctors avoid giving chemotherapy during the 1st trimester of pregnancy. The unborn baby (foetus) is developing its major organs during this time and chemotherapy could harm this process. There is also a greater possibility of miscarriage and stillbirth if you have chemotherapy during the first trimester of pregnancy. The risks are highest during weeks 2–8 of pregnancy.
Wherever possible, doctors delay treatment until the second trimester. Steroids can be very effective at delaying the need for chemotherapy. They are considered safe at any stage of pregnancy.
If you need to begin treatment immediately, you may be advised not to continue with the pregnancy. Abortion for medical reasons is known as a ‘therapeutic abortion’.
At the time of writing, women in Northern Ireland must travel to England for a therapeutic abortion; as of October 2019, funding is available for this. By April 2020, it is expected that the procedure will be available locally.
Therapeutic abortion can be extremely difficult to deal with emotionally. There is support available, for example counselling, support groups and online forums – ask your medical team to signpost you. Pregnancy Choices offer a range of support services, including counselling centres that are free of charge. They have branches across England, Scotland and Wales, and one in Carrickfergus, Northern Ireland.
In general, chemotherapy is considered to be safe for women who are in the 2nd or 3rd trimester of pregnancy. The placenta acts as a barrier that prevents many drugs from reaching your unborn baby. This is the case with ABVD, a common regimen for people with Hodgkin lymphoma. There is less evidence available on the safety of BEACOPP during pregnancy.
Doctors typically advise that you don’t have chemotherapy within 3 weeks of your due date. This is to allow your blood counts to return to normal levels before you give birth. Your doctors should take this into account when planning your treatment.
Note: chemotherapy drugs may be present in your breast milk so you should avoid breast feeding your baby during treatment. Ask your doctor for further information.
Doctors may wait until after you have given birth before giving you radiotherapy. If you require treatment urgently, they might advise you to go ahead with it while taking suitable precautions.
Generally, only radiotherapy to the neck and chest is used during pregnancy. The total dose of radiation used is generally low enough not to put your baby at risk. In addition, doctors carefully plan your treatment to ensure that your developing baby is a safe distance from the area of your body being treated. They may also shield your baby using a lead apron.
Radiotherapy tends to pose a greater risk to a developing baby during the 2nd and 3rd trimesters of pregnancy than during the 1st. Having radiotherapy in these later stages of pregnancy may increase the risk of your child developing leukaemia or solid tumours during the first 10 years of their life. It could also affect their mental development. Your doctors should talk to you about any possible risks before you have treatment.
As targeted therapies are quite new, doctors know less about long-term effects of these drugs on newborn babies. Evidence that is currently available comes from studies on animals and the findings may not transfer to humans.
Potential risks of targeted therapies are outlined below. Please consult your doctor for advice specific to your treatment and situation.
Newborns of mothers who have had treatment for lymphoma during pregnancy are likely to have a lower number of B cells. This is a common side effect of the drug rituximab. Over time, your baby’s B cell count should reach normal levels, without long-term effects. However, it is important that your baby does not have live vaccines before their blood counts reach safe levels.
Note: Any drug treatment can get into your breast milk. You may therefore be advised not to breast feed during and for a while after treatment.
Your medical team consider your individual situation when planning your treatment. They may recommend a targeted therapy for a brief period, while keeping a close watch on your developing unborn baby.
You might be given treatments to reduce side effects of treatment or to manage the symptoms of lymphoma. Supportive care treatments include:
- antiemetics (anti-sickness medication) – considered safe to a developing baby
- antibiotics – some of which should not be taken during pregnancy
- growth factors (eg granulocyte-colony stimulating factor [G-CSF]) – evidence available suggests there are no harmful effects on a developing baby.
The risk of developing a blood clot increases with pregnancy and with cancer. Your doctor will advise you on reducing the risk of developing a clot. In some cases, they may recommend that you take a blood thinning medication called heparin.
Speak to your medical team for advice about which supportive care treatments are safe for you.
Lymphoma and pregnancy can each be challenging to live with, both physically and emotionally.
Some treatments and medications to help with the symptoms of pregnancy or lymphoma may be unsafe for you – speak to your medical team for advice about what you can do to stay as comfortable as possible. Usually, your lymphoma medical team and your antenatal team work together to support you. In many cases, the pregnancy is looked after by a specialist pregnancy unit.
Your mental wellbeing is important. You may find it helpful to seek support in coping with your feelings. Mummy’s star supports women who are diagnosed with cancer during their pregnancy. They have an online emotional support forum for women who have had, or currently have, cancer during pregnancy or the postnatal period.
You may also wish to consider getting support from a trained professional to cope with your feelings. Talking therapies such as counselling can help you to understand your feelings. There are many different types, but they all share an aim to help you find ways of dealing with difficult emotions.
Speak to your medical team or your GP if you are interested in talking therapies. They may be able to refer you to an NHS therapist or you may wish to consider private counselling – the British Association for Counselling and Psychotherapy list the details of registered counsellors. You can use their online find a therapist tool to search for a therapist in your area.
Read Sue’s personal experience of having lymphoma during pregnancy.
When treatment is well-managed, pregnancy does not seem to affect the prognosis (outlook) of women who have lymphoma.
In addition, a study of 449 women with Hodgkin lymphoma found no evidence that pregnancy increases the risk of relapse among women who are in remission.
Will treatment during pregnancy affect my child later in life?
Available evidence suggests that when guidelines are followed, it is unlikely that any lymphoma treatment given during pregnancy will have a long-term, harmful impact on your baby. The treatment you’ve had is also unlikely to affect them as they develop into their childhood.