QUESTION:
My patient is a 27yo female who is 29 weeks pregnant. She has just been diagnosed with stage 3 an aplastic large cell lymphoma. Symptoms started with a swollen lymph node in her groin that progressed to her abdominal nodes and cervical nodes, with fever and severe night sweats. Pathology was confirmed positive for lymphoma and she was admitted into hospital that evening to start chemotherapy the following day (Doxorubicin, Vincristine, Cyclophosphamide and prednisone). She’s under observation in the hospital this week to see how she tolerated the first round. If it is tolerated well, they plan to do 6 rounds of treatment on a 3 week cycle. Right now I’ll be focusing on side effect management with her. The plan is to carry the pregnancy until at least 32-34 weeks before delivering the baby early.
My questions for you : Have you ever worked with cancer in pregnant women? What’s your experience with doing IVs in this population? I know high dose IV C can be very effective with lymphomas so I am interested in starting a low dose with her. Just curious about special cautions or consideration with high dose Vitamin C. Any experience or thoughts here? Once the baby comes out, I am not sure if she’ll be able to breastfeed especially if she continues on chemotherapy. Would high dose be safe in a nursing mother?
ANSWER:
They need to sign informed consent. The only thing I’ve seen is increase Braxton-Hicks contractions that resolve. Assure hydration. Also I think I’d shoot for 25-50Gram formulas during PG. Maybe just 25 since you have not done it before.
Also see:
https://www.consultdranderson.
https://www.consultdranderson.
https://www.consultdranderson.
https://www.consultdranderson.
