Women can have ‘successful and safe’ pregnancies after allogeneic transplant
Click Here to Manage Email Alerts
Key takeaways:
- Women who underwent allogeneic hematopoietic cell transplantation can have children despite the risks treatment poses to fertility.
- The findings can guide counseling of transplant recipients of child-bearing age.
Women who undergo allogeneic hematopoietic cell transplantation can get pregnant and have healthy children, according to results of a retrospective study conducted in Germany.
The findings are counter to long-held views that women cannot get pregnant after allogeneic hematopoietic cell transplantation (alloHCT).
“Some study participants reported that they had not taken measures to prevent pregnancy because their doctor told them conception was not possible,” Katja Sockel, MD, senior physician at University Hospital Carl Gustav Carus in Germany, said in a press release. “Spontaneous pregnancies should not be underestimated, and female patients should be educated about potential fertility restoration [after] alloHCT to prevent unplanned or unwanted pregnancies.”
Background and methods
Advances in alloHCT have resulted in improved long-term survival; however, transplant recipients can face fertility challenges due to chemotherapy, transplant-related morbidity and need for long-term medications, according to study background.
“Fertility is a very important topic for young female patients,” Sockel said. “Some patients even opt out of receiving certain treatments because of concerns about fertility. For young adult cancer survivors especially, the return to a normal life includes family planning.”
Prior studies have assessed the effects stem cell transplant has on fertility; however, those investigations have had several limitations, according to Sockel and colleagues. They include small sample sizes, inclusion of patients who received allogeneic or autologous transplant in the same cohorts, and a focus on pregnancies among healthy women whose male partners had undergone transplant.
Sockel and colleagues wanted to investigate fertility rates of women who received alloHCT.
Researchers used the German Registry for Stem Cell Transplantation database to build a retrospective cohort of 2,654 women aged 18 to 40 years (32% aged 35 to 40 years) who underwent alloHCT between 2003 and 2018. Nearly three-quarters (73%) had acute leukemia or myelodysplastic syndrome.
Investigators subsequently interviewed participants with documented pregnancies about conception, pregnancy course and their children’s development.
Results and next steps
Fifty women in the cohort reported 74 total pregnancies.
More than three-quarters (77%) of those pregnancies resulted in a live birth.
Median time between alloHCT and first reported pregnancy was 4.7 years. Median age at pregnancy was 29.6 years.
Most of the women who got pregnant did so between age 18 and age 25 years (62%), whereas none became pregnant between age 35 and age 40 years.
Sockel and colleagues obtained conception information from 32 women with a combined 54 pregnancies. Nearly three-quarters (72%) of those pregnancies occurred spontaneously. The others occurred through fertility assistance.
Among all women who got pregnant, 80% had undergone nonmyeloablative or reduced-intensity conditioning, and 24% had received total body irradiation.
Researchers reported an annual first live birth rate of 0.45% (95% CI, 0.31-0.59) among transplant recipients. This is about six times lower than the annual first live birth rate for the general population for that age group (3.02%).
Results showed a higher annual first live birth rate among women who had bone marrow failure or hemoglobinopathies compared with those who had malignancies (2.15% vs. 0.32%).
Among women with hematologic malignancies, receipt of myeloablative conditioning with cumulative total body irradiation doses of 8Gy or higher appeared associated with a lower annual first live birth rate (0.08% vs. 0.42%).
Sockel and colleagues identified 25 maternal complications out of 52 pregnancies for which information was available. The most common complications were vascular-related (n = 16), followed by uterovaginal complications (n = 6).
After median follow-up of 8.9 years, all of the women who got pregnant after alloHCT remained alive. Only one had developed disease relapse.
Researchers obtained fetal outcomes for 44 pregnancies. Of those, preterm deliveries occurred in 23%.
The majority (84%) of babies had normal birth weight. At median follow-up of 13 years, most women described their children’s physical and mental status as age appropriate.
Sockel and colleagues acknowledged study limitations, particularly its retrospective nature.
“Prospective studies are necessary to estimate how many women may not want to become pregnant in this situation and how many, despite their desire, cannot,” they wrote.
However, the results emphasize the need for clinicians to discuss the possibility of fertility with women who undergo alloHCT, researchers concluded.
“The results of this study show that female alloHCT recipients can achieve successful and safe pregnancies,” Sockel said. “These findings help provide a basis for counseling young women of childbearing age and raising awareness of and funding for different assisted reproductive technologies techniques so that patients can have a normal life after alloHCT.”
References
- Safe, successful pregnancies possible after AlloHCT (press release). Available at: https://www.hematology.org/newsroom/press-releases/2024/safe-successful-pregnancies-possible-after-allohct. Published July 15, 2024. Accessed July 15, 2024.
- Sockel K, et al. Blood. 2024;doi:10.1182/blood.2024024342/517008.
Collapse
Click Here to Manage Email Alerts