Management of the Pregnant Patient with Hodgkin's Disease

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Abstract
Fifteen pregnant women with Hodgkin''s disease were followed. Five patients had irradiation, 1000-3000 rad to the neck, mediastinum or both, during the 2nd or 3rd trimester with normal outcome of pregnancy. One patient had a spontaneous abortion in the 1st trimester after radiotherapy of 4400 rad to the breast, an estimated fetal dose of 9 rad. One patient who received chlorambucil throughout pregnancy delivered a normal infant. Six patients had therapeutic abortions; 1 had early induction of labor. In 1 patient previously treated for supradiaphragmatic Hodgkin''s disease, detection of a subdiaphragmatic relapse was delayed because of pregnancy. Abortion is recommended for patients who develop Hodgkin''s disease early in pregnancy or who have received chemotherapy or irradiation during the 1st trimester. During the latter half of pregnancy, asymptomatic disease may be closely followed but early delivery is recommended. Supradiaphragmatic, symptomatic disease can be treated with modified irradiation. For subdiaphragmatic, symptomatic or extranodal disease, single-agent chemotherapy may be preferable. Treatment requires individualization to insure that the patient will be cured and the fetus protected.