Mitoxantrone and Breastfeeding

Summary of use during lactation

Most sources consider breastfeeding to be contraindicated during maternal antineoplastic drug therapy, such as mitoxantrone.[1,2] It might be possible to breastfeed safely during intermittent therapy with an appropriate period of breastfeeding abstinence, but the duration of abstinence is not clear. In one patient, mitoxantrone was still detectable in milk 28 days after a dose of 6 mg per square meter. Chemotherapy may adversely affect the normal microbiome and chemical makeup of breastmilk.[3] Women who receive chemotherapy during pregnancy are more likely to have difficulty nursing their infant.[4]

Drug levels in milk and infant serum

Maternal Levels. A woman treated with mitoxantrone, etoposide and cytarabine for promyelocytic leukemia received 3 daily mitoxantrone doses of 6 mg per square meter intravenously. A mitoxantrone milk level of 120 mcg/L occurred immediately after the third dose. Milk mitoxantrone level dropped to a plateau value of about 20 mcg/L by 7 days after the third dose and remained at 18 mcg/L at 28 days after the last dose.[5] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

One mother received 3 daily doses of 6 mg/sq. m. of mitoxantrone intravenously along with 5 daily doses of etoposide 80 mg/sq. m. and cytarabine 170 mg/sq. m. intravenously. She resumed breastfeeding her infant 3 weeks after the third dose of mitoxantrone at a time when mitoxantrone was still detectable in milk. The infant had no apparent abnormalities at 16 months of age.[5]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

(Multiple Sclerosis) Glatiramer, Immune Globulin, Interferon Beta

References

1. Pistilli B, Bellettini G, Giovannetti E, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev 2013;39:207-1123199900 PubMed
2. Almas S, Vance J, Baker T, et al. Management of multiple sclerosis in the breastfeeding mother. Mult Scler Int 2016;2016:652745826966579 PubMed
3. Urbaniak C, McMillan A, Angelini M, et al. Effect of chemotherapy on the microbiota and metabolome of human milk, a case report. Microbiome 2014;2:2425061513 PubMed
4. Stopenski S, Aslam A, Zhang X, et al. After chemotherapy treatment for maternal cancer during pregnancy, is breastfeeding possible? Breastfeed Med 2017;12:91-728170295 PubMed
5. Azuno Y, Kaku K, Fujita N, et al. Mitoxantrone and etoposide in breast milk. Am J Hematol 1995;48:131-27847330 PubMed