2137 Other alkylating agents

Busulfan exerts its alkylating effect specifically on the bone marrow, and therefore is used in leukemia therapy and in preparation for bone marrow transplantation. At least 49 pregnancies, including 31 with application during the first trimester, have been published; six children or fetuses had various malformations without pattern (Briggs 2005).

Four of 12 pregnant women treated with dacarbazine had been exposed during the first trimester. All newborn babies appeared to be normal (di Paolo 1997, Aviles 1991).

In four of 12 case reports regarding therapy with mechloretamine during the first trimester (in conjunction with other cytotoxic substances), the following anomalies were described: oligodactyly, cerebral haemorrhage, hydrocephalus, and renal anomalies (Zemlickis 1992, Mennuti 1975). There were four cases of miscarriage and two induced abortions; the other pregnancies proceeded normally (Aviles 1991).

Procarbazine is a component of the combination therapy for Hodgkin's disease and other lymphomas. Only 3 of 10 newborn babies exposed during the first trimester were healthy (Aviles 1991, Schapira 1984). The malformations reported include multiple hemangiomas, anomalies of the kidneys and limbs, cleft palate, atrial septal defects, and intrauterine growth retardation. A woman who had accidentally ingested 50mg daily for 30 days during the second trimester delivered a healthy child (Daw 1970). Since procarbazine is a weak monoamine oxidase inhibitor, hypertensive circulatory disorders may occur during simultaneous administration of synergistically acting drugs.

Thio-TEPA is the abbreviated name for triethylenethiophospho-ramide; this agent is also known as thiophosphamide. There is one case report of a woman treated for leukemia during the early third trimester with thio-TEPA 30 mg/day. There were no drug-associated abnormalities in the child (Stevens 1965).

No information is available regarding the use of chlormethin, temozolomid, and treosulfan during pregnancy. The same applies for pipobroman, which is used for the treatment of polycythemia vera, and for plicamycin.

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