In Reply We read with interest the Letter by Avilés and colleagues regarding our recent submission reporting on fetal and maternal outcomes after treatment for Hodgkin and non-Hodgkin lymphoma during pregnancy. Specifically, Avilés et al were interested in the apparent omission of the CD20-targeted agent rituximab among the patients in our study with diffuse large B-cell lymphoma (DLBCL). Rituximab is a component of standard-of-care initial therapy for DLBCL (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone). Among the 24 patients who received antenatal therapy in our study, 4 patients did receive rituximab (1 in the first trimester and 3 in the second trimester (eTable 1 in the Supplement). Also, in our series the majority of patients had classic Hodgkin lymphoma, for which rituximab would not be a standard-of-care part of front-line therapy. Only 7 patients in our review had B-cell non-Hodgkin lymphoma (4 of whom had DLBCL). Avilés et al state that among 32 cases of DLBCL involving treatment during pregnancy at their institution, 9 patients received rituximab. While there were no reported acute toxic effects, severe late infections (mainly lung) occurring in 6 of 9 children necessitated acute critical care. Rituximab was the suspected etiology behind these infectious complications.
Pinnix CC, Fanale MA. Lymphoma and Pregnancy—Reply. JAMA Oncol. 2017;3(4):567-568. doi:10.1001/jamaoncol.2016.4848