Survivors May Have Successful Pregnancies After Stem Cell Transplants

Successful and safe pregnancies are possible among cancer survivors who previously received allogeneic hematopoietic cell transplantation, recent research showed.

Family planning and pregnancy is an important topic for patients and survivors of blood cancers because of improved longer-term survival after allogeneic hematopoietic cell transplantation, a study published in Blood noted.

An allogeneic stem cell transplant is when a patient receives healthy stem cells from a donor to replace their stem cells destroyed by cancer treatment, according to the National Cancer Institute.

“Fertility is a very important topic for young female patients,” Dr. Katja Sockel, senior physician at University Hospital Carl Gustav Carus Dresden in Germany, and lead study author, said in a news release. “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.”

In the study, researchers included 2,654 women between the ages of 18 and 40 who received transplants, based on data from the German Registry for Stem Cell Transplantation. They found that 50 women experienced 74 pregnancies that occurred at a median of 4.7 years after transplant and of these women, 57 (77%) experienced live births.

Of note, the annual first birth rate was 0.45% among transplant recipients, which is considered “six times lower than in the general population,” the study stated. The researchers determined that 10 years after transplantation, the probability of a live birth was 3.4%. Preterm delivery and low birth weight were also reported to be more common than the general population (meaning those without a cancer history).

The researchers found that mostly positive fetal outcomes were reported in 44 pregnancies, which showed no increased rates of childhood illnesses or developmental delays when compared with the general population.

Incidences of preterm delivery (meaning birth before 37 weeks of pregnancy) and low birth weight (approximately 3.3 to 5.5 pounds) were higher in this survivor population, versus the general population. Specifically, 10 pregnancies resulted in preterm delivery, in which the majority occurred between 28 and 32 weeks of pregnancy. Regarding low birth weights, six newborns had lower birth weights, with one having a very low birth weight of less than approximately 3.3 pounds, the study noted.

It was also established by the researchers that the likelihood of pregnancy was more correlated with survivors who were aged 18 to 35 when they received transplantation. The median age of survivors who experienced pregnancy was 29.6 years.

Importantly, this study refuted previous research that survivors of blood cancers were not able to become pregnant following transplantation, the study stated. With this consideration, researchers also emphasized that unplanned pregnancy is still a risk and should not be underestimated.

“Some study participants reported that they had not taken measures to prevent pregnancy because their doctor told them conception was not possible,” Dr. Sockel said in the news release. “Spontaneous pregnancies should not be underestimated, and female patients should be educated about potential fertility restoration post-[transplantation] to prevent unplanned or unwanted pregnancies.”

In the study, complications that occurred to the mother were reported in 25 of 52 pregnancies. The most common complications included vascular (affecting blood vessels; 16 pregnancies), such as preeclampsia (a type of high blood pressure during pregnancy), edema (swelling from fluid trapped in the body’s tissues) and hypertension (when the pressure in blood vessels is too high). The researchers emphasized that close monitoring by transplant doctors and gynecologists is recommended to avoid maternal complications.

“The results of this study show that female [allogeneic hematopoietic stem cell transplantation] recipients can achieve successful and safe pregnancies,” said Dr. Sockel. “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 [transplantation].”

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