AML accounts for two-thirds of all acute leukemia cases reported during pregnancy [
1‐
3]. The incidence of leukemia during pregnancy is reported to be 1 in 75,000–100,000 pregnancies. However, data regarding the management of acute myeloid leukemia (AML) during pregnancy is limited, mostly to case reports and retrospective studies, which poses difficulties in establishing parameters for optimal therapy, maternal outcome, and fetal complications [
4]. The management of AML during pregnancy is complicated and remains challenging as both the maternal and fetal outcomes should be considered [
1]. Administration of chemotherapy during the first trimester of pregnancy is contraindicated due to the potential risk of teratogenicity [
5]. Mothers treated in the first trimester are more likely to experience congenital malformations, spontaneous abortion, and fetal loss. However, chemotherapy can be administered safely during the second or third trimester [
6,
7]. Aviles et al. described a report of 84 children who received chemotherapy in utero including 38 during the first trimester. The children were examined for growth, physical health, development, cytogenetic, hematological, neurological, psychological, and learning disorders. All of the children observed had a normal birth weight, a normal learning and educational performance, and no congenital, neurological, or psychological abnormalities were detected [
8]. Long-term follow up of children exposed to chemotherapy after the first trimester does not show an increased incidence of congenital malformation, preterm delivery, growth restriction, and mental disorder as compared to nonmalignant pregnant [
6,
9]. Delaying the induction of chemotherapy treatment can harmfully affect fetal growth [
10]. Untreated maternal cancer can lead to adverse pregnancy outcomes, including intrauterine growth restriction (IUGR) and fetal loss [
11].
There is a robust evidence regarding the safety of many chemotherapeutic agents during pregnancy. However, the use of 5-azacytidine presents limitation due to lack of data.
The purpose of this paper is to describe the treatment of AML during pregnancy with chemotherapy, including the rarely used hypomethylating agent 5-azacytidine.