Acute Lymphoblastic Leukemia in Pregnancy: Pregnant Women Battled Against Leukemia Until 36 Weeks of Gestation: A case report

Leukemia in pregnancy is uncommon and may be a fatal condition. Using chemotherapy treatment
during pregnancy gives adversity to the mother and fetus, resulting in a dilemma about the proper
management plan. A 33-year-old pregnant woman who is G3P2L2 presented at 22 weeks of gestation
with on-and-off back pain and progressive pancytopenia. During this admission, she was suspected to
have mild pericarditis, yet the echo report was normal. Clinically, she had small multiple axillary lymph
node enlargement, and abdominal ultrasound showed mild hepatosplenomegaly. Diagnosis of pre-B
acute lymphoblastic leukemia (pre-B ALL) was confirmed by bone marrow biopsy. She was treated with
UK-ALL protocol chemotherapeutic regimen (Table 1), considering some modifications in the standard
protocol due to pregnancy. She delivered a healthy boy by lower uterine segment cesarean section at
36 weeks of gestation. She was encouraged to breastfeed her baby for only 2 weeks in order to pursue
chemotherapy treatment afterward. Chemotherapy management during pregnancy carries more risks
to both the mother and the fetus and is more challenging to clinicians; therefore, clinicians need to be
aware of early diagnosis of leukemia and have high suspicion, especially during pregnancy.