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Medical termination of pregnancy was performed as per the International Federation of Gynaecology and Obstetrics guidelines due to first-trimester teratogenicity risks, followed by intrathecal methotrexate for central nervous system prophylaxis and induction as per the modified Berlin-Frankfurt-M\u00fcnster regimen, a paediatric-inspired protocol selected for AYA efficacy. She achieved complete remission post-induction, with minimal residual disease &lt;0.01% by flow cytometry and remained on maintenance therapy. This highlights the need for multidisciplinary management, psychological support for fertility and grief counselling. While first-trimester termination minimises fetal risks, continuing pregnancy with the incorporation of safer agents, such as vincristine and corticosteroids, post-organogenesis has yielded positive maternal-fetal outcomes in reported cases.<\/jats:p>","DOI":"10.1136\/bcr-2025-268554","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:40:16Z","timestamp":1781527216000},"page":"e268554","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["\u2018At the crossroads of creation and cure\u2019: leukaemia in pregnancy"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4346-2435","authenticated-orcid":false,"given":"Harshinee Sree","family":"Santhanam","sequence":"first","affiliation":[{"name":"Obstetrics and Gynaecology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3172-9083","authenticated-orcid":false,"given":"Suprajna","family":"Shetty","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shraddha","family":"Shetty","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Devi","family":"H B","sequence":"additional","affiliation":[{"name":"Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2026061505401287000_19.6.e268554.1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.21547"},{"key":"2026061505401287000_19.6.e268554.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2011.06.002"},{"key":"2026061505401287000_19.6.e268554.3","article-title":"Acute leukemia during pregnancy: current perspectives","volume":"20","author":"Giannakaki","year":"2024","journal-title":"Mol Clin Oncol"},{"key":"2026061505401287000_19.6.e268554.4","first-page":"824880","article-title":"Pregnancy-associated acute leukemia: a multicenter retrospective study","volume":"11","author":"Zhu","year":"2021","journal-title":"Front Oncol"},{"key":"2026061505401287000_19.6.e268554.5","first-page":"676","article-title":"Severe maternal morbidity among pregnant individuals with leukemia","volume":"142","author":"Wang","year":"2023","journal-title":"Obstet Gynecol"},{"key":"2026061505401287000_19.6.e268554.6","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-08-283580"},{"key":"2026061505401287000_19.6.e268554.7","first-page":"10120","article-title":"Cancer in pregnancy: ESMO clinical practice guidelines","volume":"8","author":"Lambertini","year":"2023","journal-title":"ESMO Open"},{"key":"2026061505401287000_19.6.e268554.8","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/jha2.682","article-title":"Acute leukemias in pregnant women: retrospective study","volume":"4","author":"Kobayashi","year":"2023","journal-title":"EJHaem"},{"key":"2026061505401287000_19.6.e268554.9","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1080\/10428194.2023.2239406","article-title":"PEG-asparaginase in pregnancy: A case series and review","volume":"64","author":"Jeffrey","year":"2023","journal-title":"Leuk Lymphoma"},{"key":"2026061505401287000_19.6.e268554.10","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1080\/10428194.2016.1222379","article-title":"Acute leukemia in pregnancy: successful maternal and fetal outcomes","volume":"58","author":"Farhadfar","year":"2017","journal-title":"Leuk Lymphoma"},{"key":"2026061505401287000_19.6.e268554.11","first-page":"444","article-title":"Hematological malignancies and pregnancy: final report of 84 children who received chemotherapy in utero","volume":"28","author":"Avil\u00e9s","year":"2014","journal-title":"Leukemia"},{"key":"2026061505401287000_19.6.e268554.12","first-page":"112","article-title":"Acute leukemia in pregnancy","volume":"33","author":"Nomura","year":"2011","journal-title":"Rev Bras Ginecol Obstet"},{"key":"2026061505401287000_19.6.e268554.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2008.03.006"},{"key":"2026061505401287000_19.6.e268554.14","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/7.4.394"},{"key":"2026061505401287000_19.6.e268554.15","doi-asserted-by":"crossref","unstructured":"Peccatori FA , Azim HA , Orecchia R , et al . 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