How to manage fertility and breastfeeding in women with HL?

Question

Hello doctor,

My 28‑year‑old daughter was diagnosed with Hodgkin lymphoma during her second trimester of pregnancy. She is now seven months pregnant, and the oncologist wants to start chemotherapy (ABVD regimen) immediately. We are terrified about the effects on the baby, but also frightened that the cancer will spread if we wait.

Her lymph nodes in her neck and chest are increasing in size, and she is experiencing night sweats and fatigue. The high‑risk pregnancy specialist is monitoring the baby closely, but we remain concerned about birth defects. She has been attempting to breastfeed her two‑year‑old, but the doctors have advised that she must stop. Her staging scans indicated stage IIB disease with B symptoms.

Can Hodgkin lymphoma be treated safely during pregnancy? Will she be able to have more children after chemotherapy?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I want to reassure you that Hodgkin lymphoma can be treated safely during pregnancy, particularly in the second and third trimesters, when organ development is complete. The ABVD chemotherapy regimen (Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) is the standard of care and has been used successfully in pregnant women with no significant increase in birth defects or long-term harm to the baby when administered after the first trimester.

Given her stage IIB disease with B symptoms (night sweats, fatigue, lymph node growth), delaying treatment could allow the cancer to progress, which may jeopardize both her health and the pregnancy. The high-risk obstetrics team is crucial for close fetal monitoring throughout treatment.

Regarding breastfeeding, unfortunately, chemotherapy drugs pass into breast milk and are not safe for infants; she should discontinue breastfeeding her two-year-old during treatment. As for future fertility, ABVD is considered one of the less gonadotoxic regimens, and many young women are able to conceive after treatment; however, fertility preservation counseling (for example, ovarian tissue freezing or egg retrieval) is ideally done before starting chemotherapy, though options may be limited at this stage of pregnancy.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.