Cancer in pregnancy is rare. So there aren't a lot of studies on NHL in pregnancy. But pregnant women with NHL seem to do as well as non-pregnant women as long as they're treated in a similar way.

There are many different types of non-Hodgkin lymphoma (NHL). They can be described as being low grade (slow growing) or high grade (fast growing). Low grade lymphomas are rare in pregnancy. But, when they happen treatment can usually be delayed until after the baby is born. High grade NHL can grow quickly. So, it needs to be treated with chemotherapy as soon as possible.

Chemotherapy is usually avoided during the first three months of pregnancy because of the risks to the unborn baby. So if NHL is diagnosed in early pregnancy a woman may be advised to end her pregnancy (termination).

After the first three months chemotherapy seems to carry little risk to the unborn baby. If a woman is in the last three months of her pregnancy her baby may be delivered early, when it is safe to do so, before starting chemotherapy.

Rituximab is a new type of drug which is often used along with chemotherapy to treat NHL. There are a few reports of it having being given during pregnancy without causing serious harm to the baby but it hasn't been given often enough to know how safe it is or whether it causes any long term problems. So, rituximab may be delayed until after the baby is born.

NHL during pregnancy is a stressful situation. The news of cancer comes at a time which is usually joyful. Difficult decisions may need to be made about whether to continue with the pregnancy or not. It's often hard to balance the best treatment for the mother with the survival or safety of the unborn baby.

A woman with NHL in pregnancy is looked after jointly by her cancer specialist and her obstetrician (doctor who specialises in childbirth). And she should always be fully involved. She needs to understand her illness and how treatment may affect her and her pregnancy so that she can make her own decisions. Your daughter will need careful discussion with her doctors, partner and family. There is also specialist support available from nurses and counsellors.

References

• Cancer and pregnancy: Poena magna, not anymore, European Journal of Cancer 42 (2006) 126 -140
• Rituximab plus CHOP for treatment of diffuse large B-cell lymphoma during second trimester of pregnancy, The Lancet Oncology Vol 7 August 2006
• Use of chemotherapy during human pregnancy, The Lancet Oncology Vol 5 May 2004