PDF(Pubmed)
Abstract：
The widely use of non-invasive prenatal testing (NIPT) may lead to accidental findings and the discovery of malignancy in pregnancy, often in asymptomatic patients. Diagnosis of such subclinical malignancy during pregnancy in the asymptomatic patient poses a predicament for both doctor and patient. The risks and benefits of possible treatment for both mother and child have to be weighted, and there is often limited scientific evidence available. We present a case of an abnormal NIPT result, leading to the diagnosis of acute myeloid leukemia (AML) in an asymptomatic pregnant patient. After multiple multidisciplinary meetings and an elaborate shared decision making (SDM) process, a watch and wait strategy was implemented, in contradiction with general treatment recommendations. Following this approach, it was possible to achieve a near term pregnancy before delivery of a healthy baby girl. The patient could subsequently commence treatment of her AML and is still in complete remission after a follow-up of 25 months. Our case report highlights the possibility of watch and wait strategy in selected cases and the importance of multidisciplinary collaboration and SDM, when faced with the accidental finding of AML through NIPT.
摘要：
非侵入性产前检测（NIPT）的广泛使用可能导致意外发现和发现妊娠恶性肿瘤，通常在无症状患者中。无症状患者在怀孕期间对这种亚临床恶性肿瘤的诊断对医生和患者都构成了困境。对母亲和孩子可能的治疗的风险和益处必须权衡，科学证据往往有限。我们提出了一个异常的NIPT结果，导致无症状妊娠患者诊断为急性髓细胞性白血病（AML）。在多次多学科会议和精心制定的共享决策（SDM）流程之后，实施了观望策略，与一般治疗建议相矛盾。按照这种方法，在分娩健康女婴之前，有可能实现近期怀孕。患者随后可以开始治疗她的AML，并且在25个月的随访后仍处于完全缓解状态。我们的案例报告强调了在选定案例中观察和等待策略的可能性，以及多学科协作和SDM的重要性。当面对通过NIPT意外发现AML时。
