Posted on Friday - 09/11/2020 to Up Close
Jiovana Rodriguez-Perez and her husband had been trying to have a baby for 12 years, but last October they had given up hope of becoming parents and decided to buy a French bulldog puppy “because we wanted to raise something,” Jiovana said. However, to the couple’s surprise and joy, just three months after bringing puppy, Bruno, home to Reedley, Jiovana learned she was pregnant.
Elation quickly turned to concern, however, when laboratory blood tests showed Jiovana had an abnormally low platelet count, and she was admitted to Community Regional Medical Center (CRMC) for more tests. A bone marrow biopsy – performed at bedside without sedation because of her pregnancy – revealed she had acute myeloid leukemia (AML), a rare type of cancer that starts in the bone marrow and often quickly moves into the blood.
AML typically is a disease of older adults, and is uncommon before the age of 45. Jiovana was 32 years old and 12 weeks pregnant.
An aggressive type of blood cancer, AML can result in death if untreated, but treatment entails aggressive chemotherapy that given during pregnancy can have significant risks to the woman and fetus. Jivovana was advised of the risks to herself and the baby she carried, and was asked if she wanted to terminate her pregnancy. Jiovana made her decision. “It was a miracle I was pregnant, unless my body didn’t allow it, I didn’t want to terminate the pregnancy.”
Haifaa Abdulhaq, MD, director of hematology at UCSF Fresno and a UCSF clinical professor, was brought aboard as Jiovana’s oncologist. And Jiovana said she told Dr. Abdulhaq, “me and my baby are in your hands.”
Jiovana is now in remission and her baby, Leia Perez, is healthy, but her case was exceptional and challenging.
Pregnant women occasionally have cancer, but most often it is cancer of the breast or lymphoma – two cancers that can be treated with less-aggressive chemotherapy than the treatment regimen for AML, Dr. Abdulhaq explained. “In the whole literature, there are less than 10 or 15 cases described as acute myeloid leukemia in pregnancy,” she said. And in the literature cases, pregnancy was terminated to treat the patient or the leukemia was diagnosed later in pregnancy and it was safer to treat.”
Jiovana was barely into the second trimester of her pregnancy and she had low hemoglobin, low platelets and the leukemia cells showed in her blood. She and her unborn baby were at risk, but chemotherapy treatment needed to be held off as long as possible. Dr. Abdulhaq ordered transfusions of blood and platelets for Jiovana, but after two weeks, “I realized her platelets were going down and her white blood cell count was going higher, I could not delay treatment any longer,” Dr. Abdulhaq said.
Jiovana was admitted to CRMC, where UCSF Fresno physicians who specialize in maternal-fetal medicine monitored the baby’s in utero development for a month as Dr. Abdulhaq directed induction chemotherapy for Jiovana. “Myself and the hematology/oncology team, including fellows, kept in close contact with the physicians from maternal-fetal medicine to coordinate her care,” Dr. Abdulhaq said.
“Those first four weeks were scary,” Jiovana said. “We were praying to God, and having all my family praying that this baby will withstand the four weeks and we can go on with treatment.”
A bone marrow biopsy two weeks after chemotherapy found no evidence of leukemia. Jiovana’s blood counts improved and a second bone marrow biopsy, about a month after the treatments, also showed no sign of leukemia. Jiovana was in remission, Dr. Abdulhaq said. “I gave her two more rounds of chemotherapy during pregnancy, and then she could deliver.”
Baby Leia was born by caesarean section on July 20, and weighed 3 pounds, 6 ounces. She remained in the Neonatal Intensive Care Unit at CRMC for a month. “The only reason was she didn’t learn the bottle, but at 38 weeks, on that week’s mark, her brain just clicked and she started taking the bottle and I was able to bring her home,” Jiovana said. “She’s doing great. We’ve had two of her own doctor appointments already and the doctors are saying she is doing good.”
Jiovana received one round of consolidation chemotherapy since her delivery and is feeling good. She will be admitted to the hospital for another round of chemotherapy – the last scheduled – in October. Jiovana’s latest bone marrow biopsy, at the end of August, showed she remains in remission. She is grateful to Dr. Abdulhaq. “She took my case on and was my doctor. I’m very happy to have had her and to have her still as my doctor.”
Challenging cases, such as Jiovana’s are “honestly what keeps us going,” Dr. Abdulhaq said of UCSF Fresno physician specialists. “This is the type of situation where you feel like you can make a difference,” she said. ”Some patients think going outside of Fresno is the way to go. They don’t know that in Fresno we can manage such patients.”