ESSENTIAL THROMBOCYTHEMIA AND PREGNANCY PRELIMINARY REPORT OF THE PREGNANCY COMMITTEE OF THE
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ESSENTIAL THROMBOCYTHEMIA AND PREGNANCY PRELIMINARY REPORT OF THE PREGNANCY COMMITTEE OF THE REGISTRO ITALIANO TROMBOCITEMIE (RIT) L Melillo 1 , A Tieghi 2 , A.Candoni 3 , R Ciancia 4 , V Martinelli 4 , R Latagliata 5 , G Specchia 6 , PR Scalzulli 1 , R Fanci 7 , G Comitini 2 , N Cascavilla 1 and L Gugliotta 2 on behalf of the Registro Italiano Trombocitemie (RIT ) 1 Hematology Unit S. Giovanni Rotondo, 2 Hematology Unit Reggio Emilia, 3 Hematology Unit Udine, 4 Hematology University of Napoli, 5 Hematology University of Roma1, 6 Hematology University of Bari, 7 Hematology University of Firenze, Italy. This study is supported by a Ministero Istruzione, Università e Ricerca grant ( Grant RC0606EM71) Background • EssentialThrom bocythem ia (ET)isdiagnosed in the childbearing age in about20% ofpatients. • Fertility reduction and adverse outcom e of pregnancy due to throm botic orhem orragic com plicationsare a m atterofconcern • Pregnanciesin w om en affected by ET can be com plicated by recurrentabortion, fetalgrowth restriction,stillbirth and placentalabruction. • Presenttherapeutic approachesvary from no treatm entto treatm entwith plateletreductive agentsand/orA SA . M ethods W e evaluated theoutcom e ofpregnancy in a seriesof ET patientsobserved in 7 Italian H em atological Centres. • Study population : Sixty pregnanciesoccurring in 48 w om en w ith ET • Study Period :January 1998 -M ay 2006 • Age ,m edian 33 (range 21-45)years • Diagnosis :W H O criteria • Concomitant thrombophilic abnormalities: none • H igh-risk patients :previouspregnancy com plications orplateletcount >1,000 x10 9 /L • Management :no specific treatm entin 7 pregnancies, A SA 100 m g die in 47/60 pregnancies.LM W H for6 w eekspost-partum . Interferon alpha in 13 high-risk patients. O utcom e ofthe 24 pregnancies observed in 22 w om en w ho conceived during treatm entforET 67% 21% 8% 4% Live birth Foetal losses V oluntary abortion O ngoing O utcom e ofthe 60 pregnancies in 48 patients w ith ET 11% 10% 3% 8% 5% 48% 2% 13% 62% 1sttrim loss 2nd trim loss Still Birth V oluntary abortion Ongoing Live birth FT IUGR Prem ature live birth O utcom e ofthe 17 pregnancies treated w ith alphaIFN 6% 12% 47% 35% 82% O ngoing Foetal loss Full Term D elivery Live birth prem ature delivery Legend – GA gestational age; SA spontaneous abortion; VA voluntary abortion; A&W alive and healthy; SB still birth; FT term; IUD intrauterine death; IUGR intrauterine growth retard § Pregnancy occurred before ET diagnosis * Pregnancy started during ET treatment Patients characteristics Conclusions •These data confirm that fetal morbidity and mortality is not negligible in ET •Cytoreductive therapy with AlphaIFN seems potentially able to protect against fetal losses •Although normal pregnancies have been observed in patients who conceived during cytotoxic treatment, effective forms of contraception throughout treatment is still strongly recommended •Optimal management of pregnancy in ET patients is still poorly defined, and there are no established protocols. Recommendations for ET in pregnancy, based on current knowledge of ET and the management of inherited thrombophilia and the Antiphospholipid Syndrome in pregnancy, have been proposed ( Harrison,BJH 2005) •The epidemiological, clinical and biological data on pregnancy in ET obtained by the partecipating Centres are now object of a prospective study by the RIT, a GIMEMA projects which records the ET patients diagnosed in Italy since January 2004. Patient Age at Pregnancy ET Treatment N o of Pregnancy Antiaggregant Drug Treatment Outcome And GA MG 29 ANA 1* ASA VA 6w DC 34 ANA 1* ASA FT MM 35 ANA 1* ASA FT FP 22 ANA 1* ASA alphaIFN FT SL 24,29 ANA 2 (1§,1*) ASA alphaIFN FT GM 33 ANA 1* ASA alphaIFN FT ZO 40 ANA 1* ASA alphaIFN FT AL 25 ANA 1* ASA alphaIFN ongoing IN 45 BUS 1* ASA FT MC 32,37 HU 2 (1*) No SA 9w,A&W 32 w ME 34 HU 1* ASA SA 7w CA 36 HU 1* ASA SA 13w DG 35 HU 1* ASA FT CH 38 HU 1* No FT AL 35 IFN 1* ASA SA 14 w VI 29,31 IFN 2* ASA SA 20 w ,FT OR 30 IFN 1* ASA VA 10w FL 39 IFN 1* ASA FT DC 32 IFN 1* ASA FT MI 38 IFN 1* ASA FT CL 28 IFN 1 ASA FT RR 30 IFN 1* No ongoing AA 35 IFN 1 No alphaIFN A&W 34w DS 29 IFN 1 No alphaIFN A&W 35w TS 24,28 IFN 2* No alphaIFN FT,FT MO 33 IFN 1 ASA alphaIFN FT MD 33 NO 1§(FIVET) ASA SA 11w MA 33 NO 1 No SA 9w CE 26 NO 1 ASA VA 16w CI 28 NO 1 ASA VA 8w FS 36 NO 1 ASA VA 10w LA 29,31 NO 2 ASA SA 16w ,SA 13w PU 26,27,27 NO 3 ASA SA 8w ,SA 11w ,FT ES 22 NO 1 ASA A&W 36w TO 32 NO 1 ASA FT SA 35 NO 1§ ASA ongoing BB 38 NO 1 ASA FT TS 28,36 NO 2 ASA alphaIFN FT,FT SO 21 NO 1 No FT BA 36 NO 1 No FT MU 21 NO 1 ASA FT CA 38 NO 1 ASA FT CA 38 NO 1 No FT BE 28,3 NO 2 ASA FT,FT GG 25,26,30,32 NO 4 No alphaIFN A&W 36w ,A&W 34w ,SA8w ,SB26w EF 30,35 NO 2 ASA alphaIFN IUD 28w ,FT DFA 22 NO 1 No alphaIFN IUG R 34w
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ESSENTIAL THROMBOCYTHEMIA AND PREGNANCY PRELIMINARY REPORT OF THE PREGNANCY COMMITTEE OF THE REGISTRO ITALIANO TROMBOCITEMIE (RIT) L Melillo 1 , A Tieghi 2 , A.Candoni 3 , R Ciancia 4 , V Martinelli 4 , R Latagliata 5 , G Specchia 6 , PR Scalzulli 1 , R Fanci 7 , G Comitini 2 , - PowerPoint PPT Presentation
Transcript of ESSENTIAL THROMBOCYTHEMIA AND PREGNANCY PRELIMINARY REPORT OF THE PREGNANCY COMMITTEE OF THE
ESSENTIAL THROMBOCYTHEMIA AND PREGNANCY PRELIMINARY REPORT OF THE PREGNANCY COMMITTEE OF THE
REGISTRO ITALIANO TROMBOCITEMIE (RIT)L Melillo1, A Tieghi 2, A.Candoni 3, R Ciancia4, V Martinelli4, R Latagliata5, G Specchia6, PR Scalzulli1, R Fanci7, G Comitini2, N Cascavilla1 and L Gugliotta 2 on behalf of the Registro Italiano Trombocitemie (RIT )1Hematology Unit S. Giovanni Rotondo, 2Hematology Unit Reggio Emilia, 3Hematology Unit Udine, 4Hematology University of Napoli, 5Hematology University of Roma1, 6Hematology University of Bari, 7Hematology University of Firenze, Italy.This study is supported by a Ministero Istruzione, Università e Ricerca grant ( Grant RC0606EM71)
Background
• Essential Thrombocythemia (ET) is diagnosed in the childbearing age in about 20% of patients.
• Fertility reduction and adverse outcome of pregnancy due to thrombotic or hemorragic complications are a matter of concern
• Pregnancies in women affected by ET can be complicated by recurrent abortion, fetal growth restriction, stillbirth and placental abruction.
• Present therapeutic approaches vary from no treatment to treatment with platelet reductive agents and/or ASA.
Methods
We evaluated the outcome of pregnancy in a series of ET patients observed in 7 Italian Hematological Centres.
• Study population: Sixty pregnancies occurring in 48 women with ET
• Study Period: January 1998 - May 2006• Age, median 33 (range 21-45) years• Diagnosis: WHO criteria• Concomitant thrombophilic abnormalities: none• High-risk patients: previous pregnancy complications
or platelet count >1,000 x109 /L • Management: no specific treatment in 7 pregnancies,
ASA 100 mg die in 47/60 pregnancies. LMWH for 6 weeks post-partum. Interferon alpha in 13 high-risk patients.
Outcome of the 24 pregnancies observed in 22 women who conceived during treatment for ET
67%
21%
8% 4%
Live birth Foetal losses Voluntary abortion Ongoing
Outcome of the 60 pregnancies in 48 patients with ET
11%
10%
3%
8%
5%
48%
2%
13%
62%
1st trim loss 2nd trim loss
Still Birth Voluntary abortion
Ongoing Live birth FT
IUGR Premature live birth
Outcome of the 17 pregnancies treated with alphaIFN
6%
12%
47%
35%
82%
Ongoing Foetal loss Full Term Delivery Live birth premature delivery
Legend – GA gestational age; SA spontaneous abortion; VA voluntary abortion; A&W alive and healthy; SB still birth; FT term; IUD intrauterine death; IUGR intrauterine growth retard§ Pregnancy occurred before ET diagnosis * Pregnancy started during ET treatment
Patients characteristics
Conclusions
•These data confirm that fetal morbidity and mortality is not negligible in ET•Cytoreductive therapy with AlphaIFN seems potentially able to protect against fetal losses•Although normal pregnancies have been observed in patients who conceived during cytotoxic treatment, effective forms of contraception throughout treatment is still strongly recommended•Optimal management of pregnancy in ET patients is still poorly defined, and there are no established protocols. Recommendations for ET in pregnancy, based on current knowledge of ET and the management of inherited thrombophilia and the Antiphospholipid Syndrome in pregnancy, have been proposed ( Harrison,BJH 2005)•The epidemiological, clinical and biological data on pregnancy in ET obtained by the partecipating Centres are now object of a prospective study by the RIT, a GIMEMA projects which records the ET patients diagnosed in Italy since January 2004.
Patient Age at
Pregnancy ET
Treatment Noof
Pregnancy Antiaggregant
Drug Treatment Outcome And GA
MG 29 ANA 1* ASA VA 6w
DC 34 ANA 1* ASA FT
MM 35 ANA 1* ASA FT
FP 22 ANA 1* ASA alphaIFN FT
SL 24,29 ANA 2 (1§, 1*) ASA alphaIFN FT
GM 33 ANA 1* ASA alphaIFN FT
ZO 40 ANA 1* ASA alphaIFN FT
AL 25 ANA 1* ASA alphaIFN ongoing
IN 45 BUS 1* ASA FT
MC 32,37 HU 2 ( 1*) No SA 9w, A&W 32 w
ME 34 HU 1* ASA SA 7w
CA 36 HU 1* ASA SA 13w
DG 35 HU 1* ASA FT
CH 38 HU 1* No FT
AL 35 IFN 1* ASA SA 14 w
VI 29,31 IFN 2* ASA SA 20 w, FT
OR 30 IFN 1* ASA VA 10w
FL 39 IFN 1* ASA FT
DC 32 IFN 1* ASA FT
MI 38 IFN 1* ASA FT
CL 28 IFN 1 ASA FT
RR 30 IFN 1* No ongoing
AA 35 IFN 1 No alphaIFN A&W 34w
DS 29 IFN 1 No alphaIFN A&W 35w
TS 24,28 IFN 2* No alphaIFN FT,FT
MO 33 IFN 1 ASA alphaIFN FT
MD 33 NO 1§(FIVET) ASA SA 11w
MA 33 NO 1 No SA 9w
CE 26 NO 1 ASA VA 16w
CI 28 NO 1 ASA VA 8w
FS 36 NO 1 ASA VA 10w
LA 29,31 NO 2 ASA SA 16w,SA 13w
PU 26,27,27 NO 3 ASA SA 8w,SA 11w, FT
ES 22 NO 1 ASA A&W 36w
TO 32 NO 1 ASA FT
SA 35 NO 1§ ASA ongoing
BB 38 NO 1 ASA FT
TS 28,36 NO 2 ASA alphaIFN FT, FT
SO 21 NO 1 No FT
BA 36 NO 1 No FT
MU 21 NO 1 ASA FT
CA 38 NO 1 ASA FT
CA 38 NO 1 No FT
BE 28,3 NO 2 ASA FT,FT
GG 25,26,30,32 NO 4 No alphaIFN A&W 36w,A&W34w,SA8w,SB26w
EF 30,35 NO 2 ASA alphaIFN IUD 28w,FT
DFA 22 NO 1 No alphaIFN IUGR 34w
