2. Age specific cancer incidence US Ries LAG et al. SEER Cancer Statistics Review, 1975-2003, Available from: http://seer.cancer.gov/csr/1975_2003/

3. Pregnancy and cancer: incidence Pentheroudakis et al 2008, Annals of Oncology

4. Pregnancy and cancer: incidence Pentheroudakis et al 2008, Annals of Oncology

5. Cancer and pregnancy: incidence Berry DL et al, JCO 1999

9. Hodgkin lymphoma: treatment Stratification according to response, evaluated by PET “ Start soft, hit hard when needed” “ Hit hard and early, then adjust, if needed” Prof Volker Diehl

10. Hodgkin lymphoma during pregnancy: treatment Treatment can be started during pregnancy and continued after delivery, or postponed after delivery according to the clinical situation

11. Is immediate treatment necessary ? During 1 st trimester pregnancy termination might be considered because of higher risk of congenital anomalies. Starting from 2 nd trimester combination chemotherapy is feasible and safe. Patients close to term are good candidates to delivery anticipation. Hodgkin lymphoma during pregnancy: treatment

12. Azim HA Jr, Pavlidis N, Peccatori FA . Cancer Treat Rev 2010 Hodgkin lymphoma during pregnancy: treatment

13. Non Hodgkin lymphoma during pregnancy: issues Different approaches according to pathology subtypes ! Watchful waiting is safe in most indolent lymphoma patients (low grade follicular lymphoma, marginal zone lymphoma, lymphocytic lymphoma) BUT MOST PREGNANT PATIENTS WITH NON HODGKIN LYMPHOMAS HAVE AGGRESSIVE HISTOLOGIES !!

17. NHL during pregnancy: systemic treatment Azim HA Jr, Pavlidis N, Peccatori FA . Cancer Treat Rev 2010

18. What about Rituximab ? NHL during pregnancy: systemic treatment

20. Rituximab during pregnancy Azim HA Jr, Azim A, Peccatori FA. Expert Rev Clin Immunol 2010

21. Rituximab during pregnancy Azim HA Jr, Azim A, Peccatori FA. Expert Rev Clin Immunol 2010

22. Rituximab during pregnancy Birte et al. Hematologica 2006

23. NHL during pregnancy: radiation treatment Peccatori FA, Azim HA Jr, Pruneri G et al, JCO 2009

24. NHL during pregnancy: radiation treatment Peccatori FA, Azim HA Jr, Pruneri G et al, JCO 2009 CD3 CD30 NPM-ALK t(2;5)(q23;q35) H/E BM

25. NHL during pregnancy: radiation treatment Peccatori FA, Azim HA Jr, Pruneri G et al, JCO 2009 20 weeks pregnant, Stage Ia 10x10 cm field LINAC 6MeV 36 Gy in 18 fractions Max estimated fetal dose: 0.0004 Gy Mother & baby alive and well 4 years after diagnosis

26. Leukemia during pregnancy : incidence Pentheroudakis et al 2008, Annals of Oncology

28. Leukemia during pregnancy : treatment During 1 st trimester pregnancy termination might be considered because of higher risk of congenital anomalies. Starting from 2 nd trimester combination chemotherapy is feasible, with some caveats. Patients close to term are good candidates to delivery anticipation.

29. Leukemia during pregnancy : treatment During 1 st trimester pregnancy termination might be considered because of higher risk of congenital anomalies. Starting from 2 nd trimester combination chemotherapy is feasible, with some caveats. Patients close to term are good candidates to delivery anticipation.

31. Azim HA Jr, Pavlidis N, Peccatori FA . Cancer Treat Rev 2010

32. ALL during pregnancy : treatment Azim HA Jr, Pavlidis N, Peccatori FA . Cancer Treat Rev 2010

33. Chronic myeloid leukemia (CML) 15% of adult leukemias Continuous Imatinib administration revolutionized treatment and prognosis

39. Omphalocele

40. Imatinib during 1 st trimester has a considerable risk of congenital anomalies and spontaneous abortion; but several uneventful pregnancies reported Interferon-alpha can be safely administered throughout the course of pregnancy Shift from Imatinib to IFN (or nothing) before conceiving? CML during pregnancy

41. Haematological malignancies in pregnancy are rare and difficult to treat Treatment individualized according to: patient willing gestational age disease histology and stage Chemotherapy always administered after the first trimester, when needed Doxorubicin or Epirubicin safer than Daunorubicin or Idarubicin Conclusions

42. Cancer and Pregnancy [email_address] Thank you ! 11 th Pan Arab Cancer Congress, Casablanca, Morocco