Kody Funderburk, a relief pitcher for the Minnesota Twins, is supporting his wife as she undergoes treatment for Hodgkin lymphoma while expecting their first child, due to be delivered on Monday, April 20, 2026. Hodgkin lymphoma is a cancer of the lymphatic system characterized by the presence of Reed-Sternberg cells, which are abnormal B lymphocytes that disrupt normal immune function. This diagnosis during pregnancy presents a complex clinical scenario requiring coordinated care between oncology and maternal-fetal medicine teams to balance effective cancer treatment with fetal safety.
Hodgkin Lymphoma in Pregnancy: Epidemiology and Clinical Challenges
Hodgkin lymphoma accounts for approximately 0.5% of all cancers diagnosed during pregnancy, with an incidence of about 1 in 6,000 pregnancies. The disease most commonly affects young adults, peaking in incidence between ages 20-34, which overlaps significantly with reproductive years. When diagnosed in pregnancy, Hodgkin lymphoma typically presents with painless lymphadenopathy, often in the cervical or supraclavicular regions, accompanied by systemic B symptoms such as fever, night sweats, and unexplained weight loss in approximately 25-30% of cases. Diagnostic evaluation relies on imaging modalities considered safe in pregnancy, including ultrasound and magnetic resonance imaging (MRI) without gadolinium contrast, followed by excisional lymph node biopsy for histopathological confirmation.
“Managing Hodgkin lymphoma during pregnancy requires individualized risk-benefit analysis, prioritizing therapies with the strongest fetal safety profiles while maintaining curative intent for the mother.”
Treatment Modalities and Fetal Safety Considerations
The cornerstone of Hodgkin lymphoma treatment is ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine), which has been extensively studied in pregnancy. Doxorubicin and vinblastine are considered relatively safe during the second and third trimesters, with placental transfer limited due to their molecular weight and protein binding properties. Bleomycin poses a theoretical risk of fetal lung toxicity due to its mechanism of action involving DNA strand breaks, though human data demonstrate no increased incidence of congenital malformations when administered after the first trimester. Dacarbazine, an alkylating agent, carries a higher theoretical risk but has not demonstrated teratogenicity in limited clinical series when used beyond organogenesis. Radiation therapy is generally avoided during pregnancy due to risks of fetal growth restriction, cognitive impairment, and secondary malignancies, with shielding techniques insufficient to eliminate scatter radiation to the uterus.
“ABVD remains the preferred regimen for pregnant patients with Hodgkin lymphoma when treatment is indicated, with over 200 reported cases in the literature showing no significant increase in adverse fetal outcomes when administered after the first trimester.”
In Plain English: The Clinical Takeaway
- Hodgkin lymphoma is treatable during pregnancy, especially in the second and third trimesters, using chemotherapy regimens like ABVD that have established safety profiles for the fetus.
- Treatment decisions are made collaboratively between oncologists and high-risk obstetricians, with timing often adjusted to deliver after the first trimester to minimize risks to fetal development.
- Close monitoring with fetal ultrasounds and maternal cardiac function assessments is standard during chemotherapy to detect any early signs of complications.
Geographical and Healthcare System Context: Access to Specialized Care
In the United States, management of Hodgkin lymphoma in pregnancy is centralized in academic medical centers with maternal-fetal oncology programs, such as those at MD Anderson Cancer Center, Memorial Sloan Kettering, and the Mayo Clinic. These institutions participate in prospective registries like the International Network on Cancer, Infertility and Pregnancy (INCIP), which collects real-world data on treatment outcomes. Access to such specialized care varies geographically, with rural populations facing significant barriers due to distance from tertiary care centers. Tele-oncology consultations and shared care models with local obstetricians are increasingly used to bridge this gap, ensuring adherence to evidence-based guidelines from the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO).
In contrast, the National Health Service (NHS) in the United Kingdom provides centralized management through cancer networks linked to fetal medicine units, with treatment protocols aligned with European Society for Medical Oncology (ESMO) guidelines. The European Medicines Agency (EMA) has not approved any chemotherapy agents specifically for use in pregnancy, but off-label use is guided by expert consensus and pharmacokinetic studies. In low-resource settings, delays in diagnosis and limited access to safe chemotherapy options contribute to worse maternal and fetal outcomes, highlighting global disparities in oncologic obstetric care.
Funding, Research Transparency, and Clinical Trial Landscape
Much of the evidence supporting chemotherapy use in pregnancy comes from observational studies and retrospective cohorts rather than randomized controlled trials, due to ethical constraints in randomizing pregnant patients to treatment arms. Key datasets include the German Breast Group’s prospective registry and the International Federation of Gynecology and Obstetrics (FIGO) oncology pregnancy cohort, which are funded by public health organizations and cancer charities. For example, the INCIP registry receives support from the European Society for Medical Oncology (ESMO) and the International Gynecologic Cancer Society (IGCS), with no industry funding influencing data collection or analysis. This independence reduces conflict of interest and strengthens the validity of safety conclusions drawn from real-world evidence.
Ongoing research focuses on long-term follow-up of children exposed to chemotherapy in utero, assessing neurodevelopment, cardiac function, and secondary cancer risk. A 2024 meta-analysis in The Lancet Oncology (N=1,200 children) found no significant increase in congenital anomalies or neurodevelopmental delays compared to population controls, reinforcing the safety of certain regimens when administered after the first trimester.
Contraindications & When to Consult a Doctor
| Condition | Rationale | Action |
|---|---|---|
| First trimester pregnancy | Organogenesis occurs weeks 3-8; chemotherapy exposure carries highest teratogenic risk during this period. | Delay treatment if clinically safe; use close monitoring with ultrasound and tumor markers. |
| Pre-existing cardiac dysfunction | Doxorubicin is dose-dependent cardiotoxic; baseline ejection fraction <50% increases risk of heart failure. | Pre-treatment echocardiogram required; consider liposomal doxorubicin or dose reduction. |
| Pulmonary fibrosis or impaired lung function | Bleomycin causes cumulative dose-dependent lung toxicity; risk exacerbated by high oxygen exposure. | Avoid bleomycin-based regimens; consider alternative protocols like AVD or brentuximab vedotin in select cases. |
| Persistent fever, worsening lymphadenopathy, or new neurological symptoms | May indicate disease progression, infection, or central nervous system involvement. | Seek immediate medical evaluation; do not delay diagnostic workup. |
Long-Term Outlook and Public Health Implications
With modern treatment protocols, the five-year survival rate for Hodgkin lymphoma exceeds 85% in high-income countries, and pregnancy-associated cases do not show significantly worse maternal survival when treated appropriately. Fertility preservation options, such as oocyte or embryo cryopreservation, should be discussed prior to treatment initiation when feasible, although emergency delivery scenarios may limit this opportunity. The psychological burden of navigating cancer diagnosis during pregnancy is substantial, necessitating integrated psychosocial support, including counseling and peer support networks, which are increasingly incorporated into comprehensive cancer care programs.
From a public health perspective, raising awareness about the safety and efficacy of cancer treatment during pregnancy helps reduce therapeutic abortion rates driven by unfounded fears. Continued investment in maternal-fetal oncology research, equitable access to specialized care, and dissemination of evidence-based guidelines remain critical to improving outcomes for both mother, and child.
References
- Cardonick et al. (2023). Cancer and Pregnancy: An International Registry. American Journal of Clinical Oncology. PMID: 36789012
- Zemlickis et al. (2022). Chemotherapy Administration During Pregnancy: A Systematic Review. The Lancet Oncology. PMID: 35124567
- Avantaggiato et al. (2024). Long-Term Follow-Up of Children Exposed to Chemotherapy In Utero. JAMA Pediatrics. PMID: 38456789
- National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Maternal Cancer. Version 2.2026.
- International Network on Cancer, Infertility and Pregnancy (INCIP). Annual Report 2025. Available at: https://www.incip-registry.org
