MANAGEMENT OF CHEMOTHERAPY IN A PREGNANCY COMPLICATED BY A LARGE NEUROBLASTOMA

BackgroundThe English literature contains infrequent reports of neuroendocrine carcinoma during pregnancy. The chemotherapy for this type of malignancy can cause severe nausea and neutropenia. We used recently developed modalities to ameliorate these side effects.CaseA 22-year-old woman, gravida 4, para 2–0–1–2, presented at 24 weeksʼ gestation with a complaint of massive lower-extremity edema. Computed tomography scan delineated a large retroperitoneal mass. Biopsy of a small neck mass revealed a poorly differentiated neuroblastoma. A multidisciplinary approach to therapy was undertaken. The patient received cisplatin and etoposide chemotherapy. Complications of the first course included severe neutropenia and nausea with vomiting. Filgrastim and ondansetron were used to treat these complications. She delivered an 1825-g healthy male by cesarean for fetal distress at 35 weeks. No anomalies were noted at birth. Neonatal hematologic indices were normal.ConclusionA multidisciplinary approach to rare malignancies is warranted in pregnancy. Filgrastim and ondansetron are effective agents in the treatment of chemotherapy-associated complications. Their use in pregnancy warrants further investigation.