According to a recent study published in Blood, women who have undergone allogeneic hematopoietic cell transplantation (HCT) can safely conceive and carry pregnancies to term. The retrospective analysis included data from 2,654 female patients in Germany who underwent allogeneic HCT between 2003 and 2018. Among them, 50 women reported a total of 74 pregnancies, resulting in 57 live births (77% success rate).
The median time from transplant to first pregnancy was 4.7 years, with most pregnancies occurring in women aged 18 to 35 years at the time of transplant, and the median age at pregnancy being 29.6 years. The annual first birth rate post-transplant was notably lower at 0.45% compared to the general population’s rate of 3.02%. However, the likelihood of a live birth 10 years post-transplant was 3.4%.
Factors associated with increased rates of successful pregnancies included receiving non-myeloablative or reduced-intensity conditioning regimens, having transplants for non-malignant conditions, and lower-dose total body irradiation (TBI) or no TBI (< 8 Gy).
Lead study author Dr. Katja Sockel emphasized the significance of these findings for counseling young women of childbearing age who have undergone allogeneic HCT. She highlighted the need for awareness and funding for assisted reproductive techniques to support these patients in achieving normal reproductive outcomes post-transplant.
The study also identified maternal complications in 25 out of 52 pregnancies, primarily vascular in nature. Notably, fetal outcomes did not show increased rates of childhood illnesses or developmental delays compared to the general population, though preterm delivery rates and low birth weights were higher.
The authors recommended close interdisciplinary monitoring by transplant physicians and gynecologists to mitigate maternal complications. They acknowledged study limitations such as its retrospective nature, potential underreporting of unsuccessful pregnancies, and challenges in collecting comprehensive data on fertility and pregnancy outcomes.
In conclusion, while challenges remain, the study provides encouraging evidence that successful pregnancies are achievable following allogeneic HCT, offering hope and guidance for patient counseling and future research in this area.
