Non-Hodgkin’s lymphoma treatment in early pregnancy: dilemmas between risks and benefits

Background: Malignancy during pregnancy can cause medical complications and quandaries therefore it necessitates careful consideration of the risks and benefits of therapy for the mother’s and fetus’s safety, as well as the impact on the fetus’s health and development. In this case report, we highlight important aspects of a pregnant woman with second trimester who had non-Hodgkin’s lymphoma (NHL) receiving chemotherapy. Case presentation: A 20-years old pregnant woman was referred to One-Stop Oncology Outpatient clinics (POSA) at Dr. Soetomo General Academic Hospital. The patient complained that during the first semester, the patient felt a lump in the right neck with the size of a marble (±1.5 cm), dense, supple, sticky, firm boundaries, and growing over time. The patient reported tired and nauseous almost every day, had lost 5 kg in one month, and also had night sweats. The patient slept in a sitting position to reduce complaints of shortness of breath and a feeling of chest tightening. Based on CT scan, cytology of fine needle aspiration biopsy (FNAB) and immunohistochemistry (IHC) examination the patient was diagnosed with NHL of right neck and mediastinum, stage IIB+ superior vena cava syndrome (SVCS) and microcytic hypochromic anemia. The patient was treated using the CHOP chemotherapy regimen, with doses based on body surface area: C (cyclophosphamide): 1.065 mg/iv, H (doxorubicin): 71 mg/iv, O (vincristine): 1.98 mg/iv and P (prednisone): 100 mg/day and discharged on the 13^th day of the admission. However, four months after hospital admission, the patient had an obstetric ultrasound and the fetal had reduced heart rate. Pregnancy was terminated with a cesarean section resulting in a live baby with 2300 g body weight. Conclusion: Chemotherapy on pregnant women should be considered after evaluating the benefits and negative effects for both mother and fetus. The consideration should be based on the evaluations from multidisciplinary aspects.