Rodriguez, Andrew

Abstract Background: Glioma diagnosed during pregnancy and pregnancy following glioma treatment present complex management challenges. The safety of glioma treatment during pregnancy is not well established. The ability to counsel patients on timing of conception after treatment remains limited. The aim of this study was to review our institution’s experience with glioma during and before pregnancy. Methods: In this single-institution study, we retrospectively identified patients diagnosed with glioma during or prior to pregnancy and reviewed treatment course and maternal and neonatal outcomes. Results: Twenty-one female patients were included in our study. Glioma diagnoses included 12 high-grade tumors and 9 low-grade tumors. Cohort A consisted of 8 patients who presented with glioma during pregnancy, of which, 7 underwent glioma treatment during pregnancy. All pregnancies in cohort A were without significant maternal complications and resulted in delivery of a healthy neonate. Cohort B consisted of 13 patients who experienced pregnancy after a prior diagnosis of glioma, totaling 23 pregnancies. Antepartum course was complicated by seizure in three pregnancies. Functionally inconsequential anatomic abnormalities in childhood offspring of cohort B occurred in 5 (27.8%) of the pregnancies. Four of the offspring with anatomic abnormalities had exposure to TMZ prior to conception. Conclusions: In this retrospective series, diagnosis of glioma before or during pregnancy was associated with generally favorable maternal, fetal and childhood outcomes. We observed a higher-than-expected rate of anatomic abnormalities in the post-diagnosis cohort, though none carried meaningful functional consequences. These findings add to the limited literature exploring maternal and fetal outcomes in patients with glioma.

Abstract Improvements in treatments and prognosis in glioma patients has led patients the opportunity for pregnancy despite their diagnosis. In this retrospective case series of 13 patients evaluated at Mayo Clinic, we identified patients who were pregnant at or after glioma diagnosis from 1998-2019. Clinical information was obtained through the electronic medical record. Tumor grade, treatments, peripartum complications, and pediatric outcomes were analyzed. Median follow-up for pregnant patients was 13.5 years (range, 0-24). Of the 13 patients, 2 patients received temozolomide and radiation during pregnancy for glioblastoma and had no peripartum complications. Median survival time in these patients after further treatments was 23.5 months (range, 23.3-23.8). Two children from these pregnancies had no fetal malformations or pediatric developmental delays with median follow-up of 8.8 years (range, 4.7-12.8). Three patients received radiation during pregnancy for high grade gliomas and had no fetal malformations or peripartum complications. Eight patients had one or multiple pregnancies with median 2 (range, 1-3) children at or after diagnosis with 14 children total. Eleven of the 14 children had no fetal malformations or peripartum complications and were conceived without reproductive assistive technologies. Two children, who were identical twins, were born with a placental malformation but otherwise had normal pediatric development. One child was born pre-term and had long-term developmental delays.

Background: Longitudinally extensive transverse myelitis (LETM) accompanying systemic lupus erythematosus (SLE) is often due to coexisting aquaporin-4-IgG seropositive neuromyelitis optica spectrum disorder but has not been associated with myelin oligodendrocyte glycoprotein-IgG (MOG-IgG). Objective and methods: Case report at an academic medical center. Results: A 32-year-old woman developed severe transverse myelitis (paraplegia) shortly after SLE onset in the post-partum period. Magnetic resonance imaging (MRI) revealed an LETM, cerebrospinal fluid showed marked inflammation, and testing for infections was negative. Serum live-cell-based assay for MOG-IgG was positive but aquaporin-4-IgG was negative. Conclusion: In patients with SLE and LETM, MOG-IgG testing should be considered, in addition to AQP4-IgG.