A landmark set of guidelines has been introduced to aid in the diagnosis and expert management of serious blood cancers during pregnancy, addressing a growing medical challenge that has long lacked standardized protocols. The incidence of blood cancers such as acute leukaemia and aggressive lymphomas has been steadily rising, now affecting approximately 12.5 pregnancies per 100,000. This increase, observed at a rate of 2.7 percent per year between 1994 and 2013, has been attributed to factors such as delayed childbearing, advancements in diagnostic techniques, and greater engagement with healthcare systems.

Recognizing the urgent need for structured clinical approaches, an Australian working group has published a position statement in The Lancet Haematology, outlining best practices based on current evidence and expert consensus. These guidelines provide comprehensive recommendations covering various critical aspects, including diagnosis and staging, imaging safety, therapeutic interventions, supportive care, oncofertility, and management of pregnancy and childbirth. The aim is to equip healthcare professionals with a practical framework to ensure both maternal and fetal well-being.

Dr. Georgia Mills from Macquarie Medical School, the lead author of the guidelines, highlights the emotional and medical distress that accompanies a cancer diagnosis in pregnancy. “But on top of this, women can experience treatment delays, inaccurate information and communication breakdowns, all of which increases the worry associated with a cancer diagnosis and fears for their unborn baby,” she explains. She further emphasizes that inadequate sensitivity toward fertility preservation, breastfeeding, and medication risks to the fetus has led many patients to feel unsupported. “We want women and their babies to experience the best possible health outcomes, not delayed or denied care,” she asserts.

The absence of dedicated clinical guidelines for blood cancer management in pregnancy has posed significant challenges for clinicians, often forcing them to navigate complex cases without a clear standard of care. Senior author Dr. Gisele Kidson-Gerber stresses the importance of a multidisciplinary approach in addressing these cases effectively. “Blood cancers in pregnancy present unique therapeutic challenges, yet there were no clinical guidelines for diagnosis or management,” she notes. “As clinicians, we have to balance the need for optimal treatment for the mother with the safety and wellbeing of the unborn child. Most treatments are possible during pregnancy, including many forms of chemotherapy, but this is not what patients expect.”

A key strength of the new guidelines is their development through co-design principles, ensuring that patient perspectives were integral to the process. A patient representative was actively involved in the working group, lending firsthand insight into the struggles faced by pregnant women diagnosed with blood cancers. Victoria Bilsland, who was diagnosed with stage 4B nodular-predominant Hodgkin’s lymphoma at 17 weeks of pregnancy, recounts her harrowing experience of misdiagnoses and dismissals before finally receiving appropriate care. “I was told I ‘needed spinal surgery’ and to ‘consider termination’, and when I declined termination as we still didn’t know the extent of the cancer, I was advised to ‘think logically’,” she recalls. Without adequate information regarding her condition, the risks to her baby, or potential treatment options, she was left navigating an overwhelming emotional and medical crisis. “How could I make an impossible decision without information? And why could no one provide me information regarding cancer and pregnancy? The process was a rollercoaster of trauma, depression and anxiety.”

Ultimately, Bilsland was placed under the care of a specialized haematological team and received appropriate treatment, allowing her to deliver a healthy son at 32 weeks. She now hopes that the new guidelines will enable other doctors to provide prompt and patient-centered care, sparing future patients the unnecessary distress that she endured.

The guidelines have received endorsements from the Society of Obstetric Medicine of Australia and New Zealand and the Haematology Society of Australia and New Zealand, reflecting their significance in shaping clinical practice. By providing a structured approach to managing blood cancers in pregnancy, these recommendations aim to minimize delays, improve patient outcomes, and foster a more compassionate and informed healthcare experience.