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G-CSF associated with more live births in women with severe neutropenia
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52nd ASH Annual Meeting
ORLANDO — Women with neutropenia who were treated with granulocyte colony-stimulating factor had a greater percentage of live births and fewer spontaneous miscarriages than women not treated with G-CSF, according to data from a poster presented here.
Researchers sought to establish treatment guidelines for using G-CSF in pregnant women with severe chronic neutropenia. They conducted a cross-sectional study that included data from 88 women who had 183 pregnancies and were enrolled in the North American branch of the Severe Chronic Neutropenia International Registry.
“In the past we recommended going off the drug because we don’t like giving drugs during pregnancy,” Laurence Boxer, MD, professor and director, Pediatric Hematology/Oncology at the University of Michigan Medical Center, Ann Arbor, told HemOnc Today. Now, however, “women who are neutropenic should remain on G-CSF throughout the pregnancy,” Boxer, who is also a section editor for HemOnc Today, said.
Of 55 untreated women who had 123 pregnancies, 37 had idiopathic neutropenia (IN); 13 had cyclic neutropenia (CyN); four had congenital neutropenia (CN); and one had autoimmune neutropenia (AN). Forty-one women (CyN=16, IN=15, CN=7, AN=3) treated with G-CSF had 60 pregnancies.
The median G-CSF dose was 1.07 mcg/kg/day for each trimester. G-CSF was administered for the duration of pregnancy in 62% (n=37) of cases; 17% (n=10) were treated in the first trimester only; 13% (n=8) were treated during the last two trimesters; 5% (n=3) were treated in two of three trimesters; and 3% (n=2) were treated in the last trimester only.
Patients treated with G-CSF had no premature labors, no serious infections and five minor infections; one patient developed severe thrombocytopenia. Complications in patients not receiving G-CSF during pregnancy included six premature labors, two serious infections, two minor infections, and one premature rupture of membranes.
There was a significant difference in the rate of miscarriage between the groups. Three (5%) spontaneous miscarriages occurred in women treated with G-CSF, whereas 32 (26%) spontaneous miscarriages occurred in non-treated women.
“The data were striking in terms of abortion,” Boxer said. He attributed the difference to infection.
Fifty-three (88%) live births resulted from 60 pregnancies in the treated group, whereas 82 (67%) live births resulted from 123 pregnancies in the untreated group.
G-CSF therapy was associated with a general trend toward fewer neonatal complications in newborns, as well as a lower rate of serious maternal complications, according to Boxer.
His recommendations for dosing depend on the subcategory of neutropenia.
“Patients with congenital neutropenia should have higher amounts than idiopathic or cyclic. It’s category dependent,” he said. “But the overall goal would be to try to maintain an absolute neutrophil cap over a thousand throughout the pregnancy.” – by Carey Cowles
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