Lymphoma and Pregnancy—Reply

In Reply We read with interest the Letter by Avilés and colleagues regarding our recent submission reporting on fetal and maternal outcomes after treatment for Hodgkin and non-Hodgkin lymphoma during pregnancy. Specifically, Avilés et al were interested in the apparent omission of the CD20-targeted agent rituximab among the patients in our study with diffuse large B-cell lymphoma (DLBCL). Rituximab is a component of standard-of-care initial therapy for DLBCL (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone). Among the 24 patients who received antenatal therapy in our study, 4 patients did receive rituximab (1 in the first trimester and 3 in the second trimester (eTable 1 in the Supplement). Also, in our series the majority of patients had classic Hodgkin lymphoma, for which rituximab would not be a standard-of-care part of front-line therapy. Only 7 patients in our review had B-cell non-Hodgkin lymphoma (4 of whom had DLBCL). Avilés et al state that among 32 cases of DLBCL involving treatment during pregnancy at their institution, 9 patients received rituximab. While there were no reported acute toxic effects, severe late infections (mainly lung) occurring in 6 of 9 children necessitated acute critical care. Rituximab was the suspected etiology behind these infectious complications.

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