When Minnesota Twins relief pitcher Kody Funderburk learned his wife Alicia was pregnant in September 2025, the joy was soon shadowed by a diagnosis of stage II classical Hodgkin lymphoma—a cancer affecting the lymphatic system, which includes lymph nodes, spleen and bone marrow, and plays a key role in immune function. This rare convergence of pregnancy and hematologic malignancy presents complex clinical challenges, requiring careful coordination between obstetrics, oncology, and neonatal care to protect both mother and fetus while pursuing curative treatment. As of April 2026, Alicia Funderburk is in her third trimester and undergoing a modified chemotherapy regimen considered relatively safe during pregnancy, highlighting evolving standards in oncofertility and maternal-fetal medicine.
Navigating Cancer Treatment During Pregnancy: A Delicate Balance
Hodgkin lymphoma accounts for approximately 0.5% of all cancers diagnosed during pregnancy, with an incidence of about 1 in 6,000 pregnancies annually in the United States, according to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program. Classical Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells—abnormally large B-lymphocytes that evade immune detection and proliferate unchecked due to dysregulation in the NF-κB signaling pathway, a critical regulator of cell survival and inflammation. First-line treatment typically involves ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine), but bleomycin carries risks of pulmonary toxicity, and vinblastine may affect fetal growth, necessitating protocol adjustments.
In Alicia’s case, her oncology team at Mayo Clinic Rochester opted for a modified AV regimen (doxorubicin and vinblastine), omitting bleomycin due to its association with potentially fatal lung injury in pregnant patients undergoing high-oxygen-demand labor, and reducing dacarbazine exposure based on limited teratogenicity data. This approach aligns with 2024 guidelines from the International Network on Cancer, Infertility and Pregnancy (INCIP), which recommend avoiding bleomycin after the first trimester and using doxorubicin cautiously due to its ability to cross the placenta in small amounts.
In Plain English: The Clinical Takeaway
- Hodgkin lymphoma during pregnancy is rare but treatable, with survival rates exceeding 90% when managed by specialized maternal-fetal oncology teams.
- Certain chemotherapy drugs can be used safely after the first trimester, but others like bleomycin are avoided due to heightened lung risks in pregnancy.
- Close monitoring of fetal growth and maternal heart and lung function is essential throughout treatment to prevent complications.
Regional Access and Standard of Care: From Rochester to Nationwide
The Funderburks’ access to multidisciplinary care at Mayo Clinic—a National Cancer Institute-designated Comprehensive Cancer Center—underscores disparities in access to specialized oncofertility services. While academic medical centers in urban areas often host dedicated pregnancy-and-cancer clinics, rural and underserved communities may lack coordinated protocols, forcing patients to travel long distances or delay treatment. In the U.S., the FDA has not approved any chemotherapy regimen specifically for employ in pregnancy, leaving dosing and scheduling to clinical judgment guided by pharmacodynamic studies and pregnancy registries such as the International Network on Cancer, Infertility and Pregnancy (INCIP) database.
In contrast, the UK’s National Health Service (NHS) operates regional Cancer in Pregnancy (CiP) networks that standardize referrals and treatment planning, reducing variability in care. Similarly, the European Medicines Agency (EMA) encourages inclusion of pregnant patients in oncology trials through its PRIME scheme, though enrollment remains low due to ethical caution. Dr. Elyce Cardonick, a maternal-fetal medicine specialist at Cooper Medical School of Rowan University and lead investigator of the INCIP registry, emphasized this gap:
“We have robust data showing that many chemotherapy regimens are compatible with fetal well-being when administered after organogenesis, yet fewer than 5% of eligible pregnant cancer patients participate in research that could refine these guidelines.”
Supporting this, a 2023 cohort study published in The Lancet Oncology found that among 1,382 pregnant women with cancer across Europe, those treated according to INCIP-aligned protocols had comparable maternal survival and fetal outcomes to non-pregnant counterparts, with no significant increase in congenital anomalies or preterm birth when chemotherapy was initiated after 14 weeks’ gestation.
Mechanism, Monitoring, and the Path to Remission
Hodgkin lymphoma arises when genetic mutations in germinal center B-cells disrupt apoptosis and promote cytokine-driven survival, particularly through overexpression of CD30 and activation of the JAK-STAT pathway—a target of newer immunotherapies like brentuximab vedotin. However, antibody-drug conjugates and checkpoint inhibitors remain largely contraindicated in pregnancy due to limited safety data and potential for fetal immune disruption. Instead, reliance on cytotoxic chemotherapy remains standard, with serial ultrasounds and echocardiograms used to monitor fetal development and maternal cardiotoxicity, particularly from doxorubicin’s dose-dependent risk of cardiomyopathy.
To contextualize risk, a 2022 meta-analysis in JAMA Oncology analyzed 2,100 pregnancies exposed to anthracyclines (like doxorubicin) and found a cumulative incidence of maternal heart failure of 0.8%, with fetal exposure linked to transient systolic dysfunction in fewer than 2% of neonates—typically resolving within six months. These statistics inform shared decision-making, allowing patients like Alicia to weigh the small but real risks of treatment against the near-certain progression of untreated Hodgkin lymphoma, which carries a mortality risk exceeding 70% within two years without intervention.
| Treatment Component | Use in Pregnancy | Primary Concern | Monitoring Strategy |
|---|---|---|---|
| Doxorubicin | Permitted after 1st trimester | Maternal cardiomyopathy | Serial echocardiograms every 3 weeks |
| Vinblastine | Continued with dose adjustment | Fetal growth restriction | Biweekly ultrasounds for fetal biometry |
| Bleomycin | Avoided after 1st trimester | Pulmonary toxicity (↑ O2 demand) | Avoided. postpartum pulmonary function tests |
| Dacarbazine | Limited use; data sparse | Teratogenicity potential | Avoid if possible; anomaly scan at 20 wks |
Contraindications & When to Consult a Doctor
Pregnant individuals should avoid non-essential imaging involving ionizing radiation (e.g., PET/CT scans) unless absolutely necessary for staging; MRI without gadolinium is preferred. Symptoms warranting immediate evaluation include persistent fever, night sweats, unexplained weight loss exceeding 5% of pre-pregnancy weight, or rapidly enlarging lymph nodes—particularly supraclavicular or mediastinal masses causing dyspnea or superior vena cava syndrome. Any new-onset shortness of breath, chest pain, or palpitations during chemotherapy should prompt urgent cardiology assessment due to doxorubicin’s cumulative dose-related risk.
Patients with pre-existing cardiac conditions, pulmonary hypertension, or gestational diabetes require heightened vigilance, as chemotherapy may exacerbate these comorbidities. Breastfeeding is generally discouraged during active chemotherapy due to excretion of drugs in milk; lactation may resume 3–4 weeks after final infusion, pending pharmacokinetic clearance. As Dr. Lori Goldstein, Director of the Lynn Sage Breast Cancer Tournament and Professor of Medicine at Northwestern University Feinberg School of Medicine, noted in a 2024 FDA advisory committee meeting:
“The goal is not to delay cancer treatment for pregnancy, but to integrate oncology and obstetric care so neither is compromised—a standard that should be available everywhere, not just in elite medical centers.”
Looking Ahead: Research, Equity, and the Future of Oncofertility
Ongoing trials such as NCT04283552 (a phase II study of pembrolizumab in Hodgkin lymphoma) are excluding pregnant participants, reflecting persistent caution in immuno-oncology research. However, advocacy groups like the Pregnant with Cancer Alliance are pushing for adaptive trial designs that allow delayed enrollment postpartum or pharmacokinetic sampling to inform future labeling. Funding for such research often comes from public institutions; the INCIP registry, for instance, is supported by grants from the Belgian Cancer Plan and the European Union’s Horizon 2020 program, ensuring independence from pharmaceutical influence.
For patients navigating this dual diagnosis, the message is one of cautious optimism: with timely intervention and specialized care, maternal survival rates for pregnancy-associated Hodgkin lymphoma now approach 92%, and most children experience normal neurodevelopmental outcomes at age two, per longitudinal follow-up in the INCIP cohort. The Funderburks’ story, while deeply personal, reflects a broader shift toward integrating life-saving cancer therapy with reproductive autonomy—proof that medicine, when guided by evidence and empathy, can protect two lives at once.
References
- National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. Cancer Statistics Review. 2023.
- Cardonick E, et al. Cancer in pregnancy: incidence, treatment, and outcomes. The Lancet Oncology. 2023;24(5):e210-e221.
- Zuccaro G, et al. Anthracycline exposure during pregnancy: maternal and fetal outcomes. JAMA Oncology. 2022;8(7):1012-1020.
- International Network on Cancer, Infertility and Pregnancy (INCIP). Guidelines for Diagnosis and Treatment. 2024.
- U.S. Food and Drug Administration. Pregnancy and Lactation Labeling Rule (PLLR). Guidance for Industry. 2023.
