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Incidence of Neonatal Neutropenia and Leukopenia After In Utero Exposure to Chemotherapy for Maternal Cancer.

In Reply: We whole heartedly agree with Dr Degennaro and colleagues that the treatment of pregnant women with cancer requires a multidisciplinary team and that close maternal and neonatal follow up should continue beyond the immediate postnatal period. The purpose of the Cancer and Pregnancy Registry maintained at Cooper Medical School at Rowan University is just that, following the women diagnosed with cancer throughout their pregnancy, then the mother infant pair is followed annually. Currently, 400 women diagnosed with cancer and their children, 288 of which were exposed to chemotherapy in utero, are being followed with the mean age at last check date of 6.2± 5 years, ages range from 3 months to 19.75 years. Similar to Amant and colleagues, we have found that the development of exposed newborns is more influenced by prematurity than antenatal chemotherapy exposure.1,2 Avilés and colleagues also found that children exposed to chemotherapy performed similarly to unexposed siblings and controls when undergoing neurologic assessments.3 Our current article on neonatal neutropenia and leukopenia agrees with Reynoso’s finding in 1987 that neutropenia or leukopenia can occur if delivery is within 3 to 4 weeks of the final chemotherapy course in pregnancy and pausing chemo by 35 weeks is current practice to avoid maternal and or neonatal myelosuppression at the time of delivery. It is interesting that anemia was found in 30% of newborns exposed to chemotherapy followed by Degennaro and colleagues. For the purposes of the current paper we did not report hemoglobin levels however looking at the children analyzed for the paper, 18% of newborns delivered within 3 weeks of the final chemotherapy were born with a hemoglobin <14 g/dL, with a mean hemoglobin of 14.1 g/dL ±SD 6. Of the children born > 3 weeks from the final chemotherapy, a hemoglobin <14 g/dL occurred in 9.4% of infants with a mean hemoglobin of 21 g/dL ±SD 14.1. We agree with Dr Degennaro and colleagues that clinicians caring for pregnant women with cancer should take into account the importance of halting chemotherapy in time to allow at least 3 weeks between chemotherapy during pregnancy and delivery. We will continue to follow the mothers and children annually, with no set end age for either patient. Anyone interested in enrolling patients in this confidential Registry can find further information at www.Cancerinpregnancy.com.