Pregnancy and family planning following alloHCT: dispelling the misconceptions
A large-scale study has found that women can get pregnant and give birth following allogeneic hematopoietic cell transplantation, refuting previous widespread claims that it was virtually impossible.
Allogeneic hematopoietic cell transplantation (alloHCT) involves the transplantation of donor stem cells into patients. It is used to treat a number of blood disorders, including sickle cell anemia and leukemia. Due to continual improvements in procedures for alloHCT and supportive therapies, we are seeing growing numbers of long-term survivors who are keen to cultivate a healthy and socially normal life. For younger women, this may involve the desire to start a family. However, the complexities of transplantation, like prolonged medication use and long-lasting effects of prior chemo- and radiation therapies, have meant that pregnancy was widely assumed not to be possible.
Katja Sockel, senior physician at University Hospital Carl Gustav Carus Dresden (Germany), and her co-authors noted a lack of studies examining the relationship between alloHCT and pregnancy. “Fertility is a very important topic for young female patients,” explains Sockel. “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.”
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To better elucidate the effects of stem cell transplantation on pregnancy, they coordinated a large multicenter retrospective study that looked at pregnancy, birth rates and associated risk factors among 18-40-year-old women on the German Registry for Stem Cell Transplantation. Of the 2,654 participants included in the study, there were 74 pregnancies resulting in 57 live births among 50 women. While these rates are around six times lower than those of the general population, they do dispel the notion that pregnancy after alloHCT transplantation is impossible.
The risk of maternal complications for transplant recipients was deemed to be similar to that of the general population. However, the authors still recommend careful monitoring of patients by medical professionals, to reduce the risk of things going awry.
Although a small proportion of the reported pregnancies were the result of assistive reproductive technologies, 72% occurred spontaneously, despite some participants having been advised that they were unable to get pregnant. This highlights the need for carefully updated family planning advice for young women post-transplantation.
Sockel concludes: “The results of this study show that female alloHCT recipients can achieve successful and safe pregnancies; these findings help provide a basis for counseling young women of childbearing age and raising awareness of and funding for different ART techniques so that patients can have a normal life after alloHCT.”
The authors hope these results will encourage further studies into the implications of alloHCT for females of reproductive age so that women can be supported more effectively through their family planning decisions.
