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Cancer in Pregnancy: Chlorambucil
Chlorambucil (Leukeran) is an alkylating antineoplastic agent.
|In vitro studies||Embryonic cells||Blocking of the initiation step of DNA replication 1|
|Animal studies *||rats and mice||Teratogenesis||Growth retardation, defects of the nervous system, cleft palate, limb defects, and impairment of renal growth 1-3|
|Male mice||Mutagenesis||Chlorambucil induces specific locus and dominant lethal mutations in germ cells of male mice 4|
|Human studies||No epidemiological studies of congenital anomalies among the infants ofwomen treated with chlorambucil during pregnancy were found.|
|Case reports||1st trim exposure||There are three case reports of human fetuses aborted after first trimester exposure to chlorambucil:|
|5 - 11 weeks||1. A male fetus with agenesis of left kidney and ureter 5|
|0 - 20 weeks (+ prednisone)||2. One fetus of a set of twins aborted, with unilateral kidney and ureter agenesis. The other fetus was apparently normal 6|
|3 - 4 weeks||3. A fetus aborted showing retinal defect 7
There are also case reports of first trimester exposure to chlorambucil without adverse effects 8-11
|2nd and 3rd trim||There are few case reports of late pregnancy exposure without adverse effects in the newborn 8|
- Ashby et al: Aspects of the teratology of cyclophosphamide (NSC-26271).Cancer Treat Report 60:477-82, 1976.
- Sadler & Kochlar: Teratogenic effects of chlorambucil on in vivo and in vitro organogenesis in mice. Teratology12: 71-8, 1975.
- Kavlock et al: Chlorambucil induced congenital renal hypoplasia:effects on basal renal function in the developing rat. Toxicology40:247-58, 1986.
- Generoso et al: Dominat lethal and heritable translocation tests with chlorambucil and melphalan in male mice. Mutat Res 345: 167-80,1995.
- Shotton & Monie: Possible teratogenic effect of chlorambucil on a human fetus. JAMA 186: 180-1, 1963.
- Steege & Caldwell: Renal agenesis after first trimester exposure to chlorambucil. South Med J 73: 1414 ? 5, 1980.
- Rugh & Skaredoff: Radiation and radiomimetic chlorambucil and the fetal retina. Arch Oftalmol 74:382-393, 1965.
- Nicholson: Cytotoxic drugs in pregnancy: review of reported cases. J Obstet Gynecol Commonw 75:307-12, 1968.
- Baynes et al: Pregnancy in a case of chronic lymphatic leukemia. Br J Obstet Gynecol 75:1165-1168, 1968.
- Jacobs et al: Management of the pregnant patient with Hodgkin?s disease. Ann Int Med 95:669-75, 1981.
- Ba-Thike: Non-Hodgkin's lymphoma in pregnancy. Asia-Oceania Journal of Obstetrics & Gynaecology 16:229-32, 1990