Leukemia is a type of cancer that impacts cells in the bone marrow. There are several types of leukemia. Acute myeloid leukemia (AML) is one of them.
While AML mostly affects older adults, younger adults can also develop the condition. This includes pregnant people.
Below, we’ll cover the details you need to know about AML in pregnancy. This includes how common it is, its symptoms, and how it’s diagnosed and treated. Keep reading to learn more.
According to the
Acute vs. chronic leukemia
Acute leukemias such as AML and ALL progress quickly. As such, they can swiftly become very serious if they’re not treated. Meanwhile, chronic leukemias progress at a slower rate.
Myeloid vs. lymphocytic
Myeloid leukemias develop in bone marrow stem cells that can become red blood cells (RBCs), platelets, and certain white blood cells (WBCs) such as neutrophils, monocytes, and eosinophils.
Lymphocytic leukemias develop in bone marrow stem cells that can become WBCs called lymphocytes. Examples of lymphocytes include T cells and B cells.
It’s possible to have AML during pregnancy. However, this is a rare occurrence.
According to information from the
The true incidence of any leukemia in pregnancy is unknown. Researchers have
AML during pregnancy isn’t only serious for a pregnant person. It can also have a serious impact on a developing fetus. The effects of leukemia can lead to complications such as:
Additionally, chemotherapy, which is often used to treat AML, can also cause potential adverse effects such as congenital defects, miscarriage, and fetal death. This is especially true when treatment is given in the first trimester.
As the number of leukemia cells in the bone marrow increases, they begin to crowd out healthy RBCs, WBCs, and platelets. When this occurs, the counts of these healthy blood cells begin to drop, leading to the symptoms of AML.
The signs and symptoms of AML can include:
- anemia, which is caused by low RBC counts and can cause:
- feelings of fatigue or weakness
- dizziness or lightheadedness
- increased infection risk, which happens due to low WBC counts
- easy bleeding or bruising, which occurs because of low platelet counts
- other general signs and symptoms such as:
According to a
In most cases, AML arises due to mutations that happen in myeloid stem cells in the bone marrow. As we mentioned earlier, these cells can go on to become RBCs, platelets, and certain types of WBCs.
Mutations in myeloid stem cells can lead to these cells growing and dividing out of control. They also don’t develop properly into healthy, functional blood cells.
Instead, these cells become a type of immature, leukemic WBC called a myeloblast. You may also see these cells referred to as leukemia cells or blasts.
As leukemia cells begin to rapidly accumulate in the bone marrow, they crowd out healthy blood cells. This leads to many of the characteristic symptoms of leukemia.
The diagnosis of AML in pregnant people is similar to that of nonpregnant people. First, a doctor will take your medical history and then perform a physical exam.
Afterward, additional tests will be ordered. These are aimed at determining the cause of your symptoms and can either confirm or rule out a diagnosis of AML.
These tests use a sample of blood taken from a vein in your arm. There are several blood tests that can be used, including:
- complete blood count, which measures the levels of different types of WBCs in your blood
- peripheral blood smear, which looks at a smeared drop of blood to assess the shape, size, and number of different blood cells
- blood chemistry tests, which can inform your doctor about your liver and kidney function as well as the levels of glucose, electrolytes, and fats in your blood
- blood clotting tests, which can help to identify problems with blood clotting
Bone marrow aspiration and biopsy
Bone marrow aspiration and biopsy involve the collection of samples from the bone marrow using special needles. These samples can then be used to look for leukemia cells. If found, leukemia cells can be further characterized using:
- immunophenotyping, which uses special dyes to look for specific markers on leukemia cells
- genetic analysis, which looks for certain changes in the chromosomes and genes of leukemia cells
Since AML is a blood cancer, it’s not associated with the formation of solid tumors. However, imaging may be used to help rule out other causes of your symptoms.
Some types of imaging aren’t safe for pregnant people. However, according to the American College of Obstetricians and Gynecologists, both MRI scans and ultrasound aren’t associated with risk and may be used when they can provide clinical benefit.
The treatment of AML during pregnancy can be very challenging, as the health of both the pregnant person and the fetus must be taken into consideration. As such, treatment must be carefully managed by a multidisciplinary healthcare team.
Because AML can grow and progress quickly, immediate treatment is typically recommended. However, the timing at which the diagnosis occurs in the pregnancy is also very important. Researchers
- 23% of AMLs are diagnosed in the first trimester
- 37% of AMLs are diagnosed in the second trimester
- 40% of AMLs are diagnosed in the third trimester
Now let’s look at what this means for AML treatment.
AML treatment in the first trimester is associated with an increased risk of miscarriage and congenital defects. Due to the easy bleeding associated with AML, experiencing a miscarriage can cause potentially dangerous complications.
A pregnant person will be educated about the risks associated with AML and its treatment in the first trimester. They may also be counseled about choosing to terminate the pregnancy.
Second or third trimester
Treatment of AML in the second or third trimester isn’t typically associated with congenital defects. However, this doesn’t mean that all risks are eliminated.
According to a
At this time, a person will also be counseled about the potential risks related to treatment. The risks of delaying treatment, which can seriously affect the health of both the pregnant person and the fetus, will also be discussed.
Treatment in the second or third trimester typically involves chemotherapy. An example of a drug regimen that’s used is daunorubicin with cytarabine. The health of the fetus will also be closely monitored throughout treatment.
The dosages of chemotherapy drugs must be carefully monitored during treatment. This is because a person’s body weight changes throughout pregnancy.
If a person is later than 32 weeks into their pregnancy, it may be recommended to deliver the baby prior to starting chemotherapy.
Supportive care doesn’t directly treat AML. However, it can help to lower symptoms of AML and keep you more comfortable. Some examples of supportive care can include:
- Blood transfusion: Blood transfusions can be used if you have anemia due to a low RBC count.
- Growth factors: Growth factors that stimulate the growth of new RBCs can also be given for anemia. These are safe to use in pregnant people.
- Antibiotics and antifungals: Antibiotics and antifungals can help to treat an infection or lower your risk of getting an infection. A doctor can prescribe you medications that are safe to use during pregnancy.
- Leukapheresis: If you have high levels of leukemia cells in your blood, leukapheresis may be used. This passes your blood through a special machine to remove the WBCs, including leukemia cells, and then returns the blood to your body. It’s thought to pose minimal risk during pregnancy.
- Pain medications: If you’re experiencing pain related to AML or its treatment, a doctor can prescribe you medications for pain that are safe for pregnant people.
AML can develop in anyone. However, there are several known risk factors for the condition. Some that may contribute to AML in pregnancy include:
- a history of smoking
- being previously exposed to:
- having a close relative who’s been diagnosed with AML
- having specific blood disorders such as:
- having certain genetic syndromes, such as:
- Fanconi anemia
- Bloom syndrome
- Diamond-Blackfan syndrome
- Li-Fraumeni syndrome
Know that having risk factors for AML doesn’t mean that you’ll absolutely develop it in the future. It means that you’re at an increased risk compared with people without risk factors.
Your outlook for AML in pregnancy can depend on many factors, including:
- the trimester in which you’re diagnosed
- how far your AML has progressed
- the specific characteristics of your AML
- which decisions are made regarding AML treatment during pregnancy
- your age and overall health
Overall, there’s little research that looks into the outcomes of people that are diagnosed with AML during their pregnancy. Let’s look into what some of the data we do have says.
Starting chemotherapy during pregnancy led to complete remission rates similar to those in nonpregnant people. Treatment with chemotherapy also led to fewer fetal complications in the second and third trimesters than in the first trimester.
- seven people delivered a healthy baby
- six people opted to terminate their pregnancy
- one person experienced a miscarriage
- four people died prior to receiving treatment
Deliveries of healthy babies included both full-term and premature deliveries. None of the babies exposed to chemotherapy had any congenital defects. Long-term follow-up found that these babies were growing and developing typically.
Of the 14 surviving people with AML, 10 experienced a complete remission after treatment. However, seven of these individuals eventually died, while three were still alive at the end of the follow-up period. A further four people had AML that was resistant to treatment and eventually died.
Depending on the outcome of your treatment, you may be able to get pregnant again after you’ve had AML. However, it’s important to remember that treatment with chemotherapy can potentially affect your fertility.
It’s important to have an open conversation with a doctor about fertility when deciding how to move forward with managing your AML. They can give you an idea of what to expect.
Now let’s tackle just a few more questions you may have about AML and pregnancy.
What other types of leukemia can happen in pregnancy?
Any type of leukemia can be diagnosed during pregnancy. However, the acute leukemias, particularly AML, are the most common.
Can AML be detected early?
According to the
Can I breastfeed if I’m being treated for AML?
Chemotherapy drugs and other medications you’re taking for your AML can be present in breast milk. As such, avoid breastfeeding while being treated for AML.
Leukemia is rare in pregnancy. When it does occur, acute leukemias, particularly AML, are the most common.
Due to the fact that it grows and progresses quickly, AML can have serious effects on both a pregnant person and a fetus. As such, treatment for AML that develops during pregnancy must be initiated as soon as possible.
The type of management that’s recommended will depend on when in the pregnancy AML is diagnosed. A doctor can help to educate you of the outcomes associated with each option so that you can make an educated decision.