New ASCO guideline maps care for pregnant women with blood cancers

MIAMI, FLORIDA (Dec. 12, 2025) – A new guideline from the American Society of Clinical Oncology (ASCO) offers clear, evidence-based direction for treating blood cancers during pregnancy and shows that many patients can safely receive timely cancer care without compromising fetal health. The guideline underscores that survival outcomes for pregnant patients with leukemia or lymphoma can match those of non-pregnant patients when treatment follows established protocols.

Imagine standing at a crossroads where the hope of new life meets the challenge of a cancer diagnosis. The new ASCO Guideline, co-authored by Mikkael Sekeres, M.D., M.S., chief of the Division of Hematology at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, serves as a guiding compass crafted by experts from leading institutions worldwide. This comprehensive resource, published by the Journal of Clinical Oncology, navigates the complexities of cancer during pregnancy, guiding treatment options for both solid tumors and blood cancers.

“I am deeply honored to lend my voice to this collaborative guideline,” said Sekeres. “Being part of a team dedicated to improving care for pregnant patients with cancer is both humbling and inspiring. It’s a privilege to help shape recommendations that can make a real difference for families facing these challenging diagnoses at a vulnerable time in their lives.”

A diagnosis of blood cancer during pregnancy can feel like walking a tightrope — each step requires careful consideration. The guideline shows that, with timely and thoughtful therapy, mothers and babies can achieve healthy outcomes. Survival rates for pregnant patients with lymphoma or leukemia are similar to those of non-pregnant patients when care follows established protocols.

“I’ve cared for a few pregnant patients with cancer during my career. And each time, treating blood cancers during pregnancy means weighing the needs of two patients. It’s about precision, compassion and making sure every decision is informed by the patient’s goals, and the best available evidence,” said Sekeres.

Navigating the diagnosis and management of blood cancers during pregnancy presents unique challenges, requiring careful consideration of both maternal and fetal health. According to the ASCO guideline, the emphasis should be on a collaborative, multidisciplinary approach to ensure the best possible outcomes. The following recommendations outline key strategies for diagnosing and treating hematologic malignancies in pregnant patients, highlighting both established protocols and individualized patient care.

• Diagnosis: The guideline recommends using ultrasound and MRI first, minimizing risk to the fetus. Core needle or bone marrow biopsies are safe and effective for confirming blood cancer diagnoses.
• Chemotherapy: After the first trimester, many standard regimens—anthracyclines, vinca alkaloids, cytarabine—can be used safely. Some drugs, such as methotrexate and high-dose alkylators, are avoided because of higher risks.
• Timing: Prompt treatment is critical. Multidisciplinary teams—including hematologists, maternal-fetal medicine specialists and neonatologists—work together to coordinate care.
• Supportive care: G-CSF and antimicrobials are used when needed. Transfusion support and infection prevention help protect both mother and baby.

“Every plan should be tailored to the individual. Sometimes treatment begins during pregnancy, sometimes we can delay it until delivery, and other times delivery is timed to allow for therapy to start,” said Sekeres. “The patient’s values and wishes guide every decision.”

The long-term data offer seeds of hope: children exposed to chemotherapy for blood cancers after the first trimester generally grow, with no significant increase in birth defects or cognitive delays. Still, the journey is not without risk—premature birth, low birth weight and transient blood count changes are possible, so close monitoring is essential.

“Luckily, children of pregnant women with cancer tend to thrive. But we never lose sight of the emotional storms our patients and families endure throughout the process,” Sekeres said. “Psychosocial support is the shelter that helps them weather the storm.”

“Every case is unique,” he added, “but our guiding principle is always the same: do what’s best for both patients. With the right team and the right information, families can move forward with confidence, even when the path is challenging.”

Read more about Sylvester research on the InventUM blog and follow @SylvesterCancer on X for the latest news on its research and care.

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Authors: A complete list of authors is available in the paper.

Article Title: Management of Cancer During Pregnancy: ASCO Guideline

DOI: 10.1200/JCO-25-02115

Funding and Disclosures: Disclosures and funding information are available in the article.

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