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)
Methods
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.
•
•
•
•
•
•
•
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.
Patients characteristics
Age at
ET
Noof
Antiaggregant
Outcome
Patient Pregnancy Treatment Pregnancy
Drug
Treatment
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
Outcome of the 60 pregnancies in
48 patients with ET
5%
8%
48%
3%
62%
10%
2%
11%
13%
1st trim loss
2nd trim loss
Still Birth
Voluntary abortion
Ongoing
Live birth FT
IUGR
Premature live birth
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
Outcome of the 17 pregnancies treated with
alphaIFN
Ongoing
Foetal loss
Full Term Delivery
Live birth premature delivery
Outcome of the 24 pregnancies observed in 22 women who
conceived during treatment for ET
Live birth
Foetal losses
Voluntary abortion
Ongoing
47%
8%
12%
4%
82%
21%
6%
35%
67%
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.