A systematic review of the interplay between cutaneous T-cell lymphoma and pregnancy has found worsening clinical outcomes among pregnant and postpartum women diagnosed with the condition.

The authors of the review, which has been published in JAAD, said dedicated prospective studies are now needed given “growing evidence that pregnancy may represent a risk factor for progression of CTCL” [link here].

The analysis included 27 studies of CTCL between 1981 to 2023, finding that among the 55 pregnancies recorded, 60.4% of patients experienced a worsening of their lymphoma during the pregnancy and postpartum periods.

This was defined as new or progressive lesions, increased symptomatic burden or stage progression. Skin changes began during pregnancy for 15% of patients, while five maternal deaths occurred during pregnancy or postpartum, four due to disease progression.

The exact lymphoma treatment was unknown in half of the cases reviewed, but no CTCL treatments were given during pregnancy for 21% of patients.

“This striking finding of worsening clinical course for pregnant and postpartum women with CTCL invites speculation as to pathogenesis, raising the possibility that the immune permissive environment of pregnancy alters immunoregulation to allow for the expansion of CTCL clones,” the authors said.

While cutaneous T-cell lymphoma has typically affected older males, a growing number of diagnoses for women and those under 40 warranted a need for closer analysis of these patient groups, they said.

The small cohort sizes of the studies reviewed were a limitation, while determining “worsening” of CTCL in the papers was open to some interpretation.

Despite this, the data suggested more work needed to be done investigate the impact of pregnancy on cancer progression for these patients.

“Fortunately, many aspects of pregnancy do not appear to be impacted by CTCL,” the investigators found.

“Notably, a number of cases ended in patient death, yet many patients did not receive treatment during pregnancy, allowing for future research on therapy safety and efficacy.”