Navigating Burkitt lymphoma treatment while pregnant
Betsy Lucas was five months pregnant when a curious dime-sized lump arose on her neck.
Her family doctor thought it was likely an inflamed lymph node caused by a recent sinus infection. But a biopsy revealed Betsy had Burkitt lymphoma, a fast-growing type of non-Hodgkin lymphoma that occurs most often in young adults and children.
“I was stunned,” Betsy says. “The bump appeared out of nowhere, overnight.”
Pregnancy poses challenges during Burkitt lymphoma treatment
At her doctor’s urging, Betsy scheduled an appointment at MD Anderson, where she met with oncologist Sairah Ahmed, M.D.
“This is going to be difficult,” Ahmed said. “We need to act quickly.”
Had Betsy not been pregnant, Ahmed would have prescribed a chemotherapy regimen that included high doses of the cancer-killing drugs cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate and cytarabine. These are typically administered along with the monoclonal antibody drug rituximab, which trains a patient’s own immune system to attack and destroy cancer cells.
The drugs are divided into two groups – group A and group B – and delivered alternately, in an A-B-A-B-A-B pattern, six times over six months.
“This combination therapy is the gold standard treatment for Burkitt lymphoma,” Ahmed says. “It produces high cure rates.”
But Betsy couldn’t follow that formula. She was pregnant, and methotrexate – one of the drugs in the chemotherapy regimen – could cause severe birth defects, or even end her pregnancy.
Betsy and her husband, Joel, were determined to protect their baby. A prenatal ultrasound had revealed she was a girl. They named her Aurelia.
“She’s been special for a long time,” Betsy says. “Keeping her safe and healthy was our top priority.”
Finding the rightBurkitt lymphoma treatment
Ahmed conferred with colleagues at MD Anderson and throughout the country to devise a treatment plan: Betsy would first receive three rounds of the Group A chemotherapy drugs, with each round spaced three weeks apart.
Then, her obstetrician at a nearby hospital – in consultation with a specialist in pregnancy and cancer – would induce labor early and Betsy would give birth to Aurelia. The baby would be premature, but well taken care of in the neonatal intensive care unit.
After giving birth, Betsy would return to MD Anderson for three cycles of the Group B drugs, which included methotrexate. With her baby already born, the drug could no longer threaten her pregnancy.
“Instead of the typical A-B-A-B-A-B chemotherapy schedule, my schedule was A-A-A, then have a baby, then B-B-B,” Betsy says.
Ahmed found only a handful of case reports in which a similar regimen had been adapted for pregnant cancer patients.
“We were breaking new ground here,” she says. “Betsy was getting the same drugs she would get if she weren’t pregnant – but in a different order.”
Video visits provide connection despite COVID-19 precautions
Because the chemotherapy drugs used to treat Burkitt lymphoma are stronger than those prescribed for many other types of cancer, patients typically are hospitalized for several days during each session.
“This allows the medical team to monitor patients and give them support for any side effects they may experience,” Ahmed explains.
Before giving birth, a steady stream of family and friends visited Betsy during her four-day hospital stays. She used a spreadsheet to schedule visitors, with naps in between. Her husband and dad took turnings staying overnight.
But by the time Aurelia was born on April 11, COVID-19 had arrived. Visitors were no longer permitted at MD Anderson.
“I was suffering from postpartum depression and I needed human contact,” Betsy says. “My baby was across the street in the NICU and I couldn’t visit her. No one could visit me, at least not in person.”
Betsy turned to FaceTime, using the same spreadsheet she’d used prior to the pandemic. But now her visitors were virtual.
“My friends and family lifted my spirits and helped me get through my remaining chemo sessions,” she says.
MD Anderson also cared for Betsy’s emotional well-being by providing psychiatric support during her bout with postpartum depression.
“I’d been very honest about how I was feeling before returning to MD Anderson,” she says. “My first day back, I arrived in my hospital room and found Diana Nichols, a psychiatric nurse practitioner, waiting for me. I’m so impressed and grateful that MD Anderson cared about my physical and my mental health during that difficult time.”
Life after Burkitt lymphoma treatment
After completing treatment in June, Betsy continues to show no evidence of disease. She’s back at work full time, teaching special education at her local elementary school.
Motherhood is ‘amazing,’ says Betsy, whose daughter is now 10 months old.
“She’s the happiest baby with the best laugh. She helped me get through treatment, because she was always with me. I was fighting for both of us.”