Successful pregnancies after allogeneic hematopoietic cell transplantation – results of a national study

A new national multicenter study offers hope for women who have undergone allogeneic hematopoietic cell transplantation (alloHCT). The results of the study, recently published in the renowned journal Blood, show that successful pregnancies are possible under certain conditions, especially in younger women, patients with non-malignant diseases, and those who received no or only low doses of total body irradiation (TBI).

For many benign hematologic disorders, allogeneic hematopoietic cell transplantation (alloHCT) is the only curative treatment option. Advances in transplantation procedures and optimized supportive therapies have led to a steady increase in long-term survivors. Especially for young adults, family planning plays an important role after surviving cancer. However, there is a high risk of treatment-related infertility after allogeneic hematopoietic cell transplantation. Despite sporadically reported pregnancies, there is a lack of systematic data on pregnancy and birth rates in female transplant recipients. In collaboration with the Cooperative Transplant Study Group (KTS), a large national project was therefore initiated to "Record pregnancies after allogeneic hematopoietic cell transplantation in Germany" under the direction of the Medical Clinic I in cooperation with the Fertility Center at the University Hospital Dresden. The project analyzed the data of all women of childbearing age (between 18 and 40 years) who had undergone an allogeneic hematopoietic cell transplant in a German transplant center between 2003 and 2018. 

Key findings:

A total of 2,654 women of childbearing age underwent transplantation in Germany between 2003 and 2018. In 50 of these women, pregnancies were documented; some became pregnant several times, resulting in a total of 74 pregnancies. The majority of the pregnancies were successful, with 57 live births. Factors such as younger age at the time of transplantation, transplants for non-malignant conditions and reduced-intensity conditioning regimen as well as lower doses (<8 Gray) of total body irradiation were associated with increased chances of maternity. Most notable was the high proportion of spontaneous pregnancies (77%), while assisted reproductive technologies (ART) were used in the remaining cases. Preterm birth and low birth weight occurred more frequently than in the general population.

Dr. Katja Sockel, lead study author, emphasizes that these data can not only be used as an important basis for everyday medical consultations on allogeneic hematopoietic cell transplantation for young patients who still wish to have children, but also provide valuable insights for the further optimization of the transplantation procedure in young patients in terms of individualized patient care.

"Optimal therapy is always linked to patient satisfaction. These findings will enable us to refine our treatment strategies and thus sustainably improve our patients' quality of life and family planning,” says Prof. D. Michael Albrecht, Medical Director.

Conclusions:

This study represents the largest data set reporting pregnancies in adult female alloHCT recipients and provides hope that successful pregnancies are realistic despite intensive treatment and health challenges. This requires early interdisciplinary collaboration between oncologists and reproductive physicians to plan fertility-preserving measures, as established at the NCT/UCC Dresden in cooperation with the Fertility Center of the Women's Clinic. Prof. Esther Troost, Dean of the Faculty of Medicine and radiation oncologist, emphasizes: "These data take us one step further towards an improved quality of life while at the same time achieving excellent oncological treatment results."

Prof. Martin Bornhäuser, Managing Director, NCT/UCC Dresden, adds: "Young adults with and after cancer represent a patient group with special needs. Achieving a normal quality of life after surviving cancer is a key goal for us at the NCT/UCC Dresden. The findings of such studies provide us with important information for improving our treatment strategies in order to reduce long-term toxicities."

In order to meet the special needs of young adult cancer patients, there are even more interdisciplinary collaborations at the University Hospital, such as the transition outpatient clinic. Here, the Pediatric Oncology Department under the direction of Prof. Schewe and the Medical Clinic I under Prof. Bornhäuser carry out long-term follow-up care for adolescents and young adults after cancer in a joint interdisciplinary consultation.

Contact

Dr. med. Katja Sockel
Medical Clinic and Polyclinic I
Carl Gustav Carus University Hospital Dresden (UKD)
Fetscherstr. 74, 01307 Dresden
katja.sockel@ukdd.de