Gestational trophoblastic neoplasia treated with low-dose induction chemotherapy despite prognostic score < 13: a case report

Background Gestational trophoblastic neoplasia (GTN) can cause significant morbidity and mortality if not appropriately recognized and treated. Low-dose induction chemotherapy is recommended for “ultra-high risk” GTN– defined as prognostic score ≥ 13 - to prevent mortality from hemorrhage that occurs when tumors respond rapidly. Case A 22-year-old patient presented with hemoptysis due to pulmonary metastases from GTN, but with WHO score < 13. A multi-disciplinary care team began treatment with low-dose induction chemotherapy to prevent worsening pulmonary hemorrhage. While she required intubation to complete induction chemotherapy, she did not suffer further pulmonary hemorrhage during treatment. Conclusion Low-dose induction chemotherapy should be considered as treatment for patients with GTN and pulmonary metastasis causing hemorrhage even if WHO score is <13.