Clinical features and maternal-fetal outcomes of patients with first-onset acute leukemia during pregnancy: a retrospective study from pregnancy hematological disease referral center

This study aimed to characterize the clinical features, maternal-fetal outcomes, and prognostic factors of pregnant patients with first-onset acute leukemia (AL) at a specialized referral center in China. A retrospective descriptive study was conducted on 53 pregnant patients diagnosed with de novo AL and treated at Peking University People’s Hospital between January 2010 and January 2024. Clinical data, including maternal baseline characteristics, treatment protocols, pregnancy outcomes, and long-term maternal/neonatal follow-up results, were collected and analyzed. Survival outcomes were estimated using Kaplan-Meier curves, and prognostic factors for maternal mortality were identified via Cox regression analysis. Of the 53 patients, 40 (75.5%) had acute myeloid leukemia (AML) and 13 (24.5%) had acute lymphoblastic leukemia (ALL); AL onset occurred in the first (n = 12, 22.6%), second (n = 28, 52.8%), and third (n = 13, 24.6%) trimesters. The most common initial symptoms were oral manifestations (34.0%, e.g., gingival bleeding/hyperplasia), while thrombocytopenia (94.3%) and anemia (86.8%) were the most prevalent peripheral blood abnormalities. 23 (43.4%) patients reached the peripartum period (≥ 28 weeks), with 56.5% preterm births and 13.0% fetal growth restriction (FGR). Gestational age at AL onset was the only factor significantly associated with peripartum progression (OR = 1.642, p < 0.001). Seven patients received antenatal induction chemotherapy, all achieving live births. Long-term follow-up (median: 4.4 years) of 17/22 live-born children showed no growth restriction or neurodevelopmental delays. The 5-year overall survival (OS) and disease-free survival (DFS) rates for mothers were 50.9% and 41.5%, respectively. Cox regression identified disseminated intravascular coagulation (DIC, HR = 5.274, p = 0.022) and leukocytosis (HR = 5.009, p = 0.025) as independent risk factors for maternal mortality; chemotherapy delay (> 30 days) was associated with lower complete remission (CR) rates (66.7% vs. 87.1%) and higher mortality (50% vs. 26.7%). Unexplained thrombocytopenia or oral manifestations are key early indicators for targeted AL screening in pregnant patients. Gestational age at AL onset was the only factor significantly associated with peripartum progression. Disseminated intravascular coagulation and leukocytosis were independent risk factors for maternal mortality. Among 17 live-born children with a median follow-up of 4.4 years, no growth restriction or neurodevelopmental delays were observed, including 6 infants exposed to antenatal ATRA-based chemotherapy.