OUTCOMES OF 121 PREGNANCIES IN PATIENTS WITH POLYCYTHEMIA VERA (PV)
(Abstract release date: 05/19/16)
EHA Library. Griesshammer M. 06/10/16; 135143; S110
Prof. Dr. Martin Griesshammer
Contributions
Contributions
Abstract
Abstract: S110
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Auditorium 1
Background
Very limited data are available regarding pregnancy (preg) outcomes in patients with PV, less than 40 pregs being reported in the literature. Within the European LeukemiaNet we collected 121 pregs in 48 PV patients from 7 centers in France, Italy, Serbia, Romania, Switzerland and Germany.
Aims
Outcomes of pregancies in patients with polycythemia vera (PV).
Methods
Pregs were categorized in two groups. Group 1 consisted of pregs before the diagnosis of PV (n=39). Group 2 (n=82) included all pregs after the diagnosis of PV. Most patients in group 2 received low dose aspirin during preg and low molecular weight heparin after delivery until the 6th week postpartum. The target hematocrit during preg was 40% and therapeutic phlebotomy was performed, if needed. Iron supplementation was not advised during preg.
Results
Median age at diagnosis of PV was 29 yrs (range 18-40), median age at delivery 32 yrs (21-43). 13 out of 48 patients (27%) had high-risk PV due to severe thromboembolic complications either at the time of diagnosis or during follow up. These included 5 Budd Chiari syndromes, 4 portal vein thromboses, 2 superior sagittal sinus thromboses, 3 deep vein thromboses, and one pulmonary embolism. In group 2, a planned medical interruption was performed in 6/82 pregs due to patients´ choice. The outcome of another 6 pregs cannot be reported yet (still ongoing in 3 and missing in another 3). Thus, a total of 70 pregs are evaluable at time of abstract submission in group 2.In group 1 live birth was recorded in 19/39 pregs (49%), while 20 pregs were unsuccessful due to spontaneous abortion (n=9; 23%), stillbirth (n=8; 21%) or late fetal loss (n=3; 8%). In contrast, outcome was significantly better in group 2 with 54 live births out of 70 pregs (77%) [chi square, p = 0,002]. In group 2 we observed 12 (17%) spontaneous abortions, one ectopic preg (1%) and 3 (4%) stillbirths. Interferon alpha was used in 12 high risk cases with 10 live births (83%) and 2 spontaneous abortions. Concerning maternal complications, the rate of severe thromboembolic events was similar between the two groups (group 1: one pulmonary embolism with cardiogenic shock (2,6%), group 2: two Budd Chiari syndromes in 3rd trimester (2,8%). There were no deaths. Of note, the bleeding rate was significantly higher in group 2 (8 minor and 3 major bleedings) which was probably due to the treatment with aspirin and low molecular weight heparin in this group while only one minor bleeding was observed in group 1 [chi square, p = 0,036]. Most PV patients’ hematocrit values spontaneously decreased during preg, thus phlebotomies were mainly performed during the first trimester. 6 twin pregs were managed in group 2, five of them resulted in live births, and one patient had a spontaneous abortion in the 22th week.
Conclusion
This is the largest series of PV pregs reported to date collected across the European LeukemiaNet network. The success rate of pregs was significantly better (49% versus 77%, respectively) for patients in whom the diagnosis of PV was known and appropriate management performed according to current guidelines. This high success rate of almost 80% is encouraging in this higher risk PV population. However, despite the use of aspirin and molecular weight heparin major thrombotic events still occur and an increased bleeding rate is observed.
Session topic: Myeloproliferative neoplasms - Clinical 1
Keyword(s): Polycythemia vera, Pregnancy
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Auditorium 1
Background
Very limited data are available regarding pregnancy (preg) outcomes in patients with PV, less than 40 pregs being reported in the literature. Within the European LeukemiaNet we collected 121 pregs in 48 PV patients from 7 centers in France, Italy, Serbia, Romania, Switzerland and Germany.
Aims
Outcomes of pregancies in patients with polycythemia vera (PV).
Methods
Pregs were categorized in two groups. Group 1 consisted of pregs before the diagnosis of PV (n=39). Group 2 (n=82) included all pregs after the diagnosis of PV. Most patients in group 2 received low dose aspirin during preg and low molecular weight heparin after delivery until the 6th week postpartum. The target hematocrit during preg was 40% and therapeutic phlebotomy was performed, if needed. Iron supplementation was not advised during preg.
Results
Median age at diagnosis of PV was 29 yrs (range 18-40), median age at delivery 32 yrs (21-43). 13 out of 48 patients (27%) had high-risk PV due to severe thromboembolic complications either at the time of diagnosis or during follow up. These included 5 Budd Chiari syndromes, 4 portal vein thromboses, 2 superior sagittal sinus thromboses, 3 deep vein thromboses, and one pulmonary embolism. In group 2, a planned medical interruption was performed in 6/82 pregs due to patients´ choice. The outcome of another 6 pregs cannot be reported yet (still ongoing in 3 and missing in another 3). Thus, a total of 70 pregs are evaluable at time of abstract submission in group 2.In group 1 live birth was recorded in 19/39 pregs (49%), while 20 pregs were unsuccessful due to spontaneous abortion (n=9; 23%), stillbirth (n=8; 21%) or late fetal loss (n=3; 8%). In contrast, outcome was significantly better in group 2 with 54 live births out of 70 pregs (77%) [chi square, p = 0,002]. In group 2 we observed 12 (17%) spontaneous abortions, one ectopic preg (1%) and 3 (4%) stillbirths. Interferon alpha was used in 12 high risk cases with 10 live births (83%) and 2 spontaneous abortions. Concerning maternal complications, the rate of severe thromboembolic events was similar between the two groups (group 1: one pulmonary embolism with cardiogenic shock (2,6%), group 2: two Budd Chiari syndromes in 3rd trimester (2,8%). There were no deaths. Of note, the bleeding rate was significantly higher in group 2 (8 minor and 3 major bleedings) which was probably due to the treatment with aspirin and low molecular weight heparin in this group while only one minor bleeding was observed in group 1 [chi square, p = 0,036]. Most PV patients’ hematocrit values spontaneously decreased during preg, thus phlebotomies were mainly performed during the first trimester. 6 twin pregs were managed in group 2, five of them resulted in live births, and one patient had a spontaneous abortion in the 22th week.
Conclusion
This is the largest series of PV pregs reported to date collected across the European LeukemiaNet network. The success rate of pregs was significantly better (49% versus 77%, respectively) for patients in whom the diagnosis of PV was known and appropriate management performed according to current guidelines. This high success rate of almost 80% is encouraging in this higher risk PV population. However, despite the use of aspirin and molecular weight heparin major thrombotic events still occur and an increased bleeding rate is observed.
Session topic: Myeloproliferative neoplasms - Clinical 1
Keyword(s): Polycythemia vera, Pregnancy
Abstract: S110
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Auditorium 1
Background
Very limited data are available regarding pregnancy (preg) outcomes in patients with PV, less than 40 pregs being reported in the literature. Within the European LeukemiaNet we collected 121 pregs in 48 PV patients from 7 centers in France, Italy, Serbia, Romania, Switzerland and Germany.
Aims
Outcomes of pregancies in patients with polycythemia vera (PV).
Methods
Pregs were categorized in two groups. Group 1 consisted of pregs before the diagnosis of PV (n=39). Group 2 (n=82) included all pregs after the diagnosis of PV. Most patients in group 2 received low dose aspirin during preg and low molecular weight heparin after delivery until the 6th week postpartum. The target hematocrit during preg was 40% and therapeutic phlebotomy was performed, if needed. Iron supplementation was not advised during preg.
Results
Median age at diagnosis of PV was 29 yrs (range 18-40), median age at delivery 32 yrs (21-43). 13 out of 48 patients (27%) had high-risk PV due to severe thromboembolic complications either at the time of diagnosis or during follow up. These included 5 Budd Chiari syndromes, 4 portal vein thromboses, 2 superior sagittal sinus thromboses, 3 deep vein thromboses, and one pulmonary embolism. In group 2, a planned medical interruption was performed in 6/82 pregs due to patients´ choice. The outcome of another 6 pregs cannot be reported yet (still ongoing in 3 and missing in another 3). Thus, a total of 70 pregs are evaluable at time of abstract submission in group 2.In group 1 live birth was recorded in 19/39 pregs (49%), while 20 pregs were unsuccessful due to spontaneous abortion (n=9; 23%), stillbirth (n=8; 21%) or late fetal loss (n=3; 8%). In contrast, outcome was significantly better in group 2 with 54 live births out of 70 pregs (77%) [chi square, p = 0,002]. In group 2 we observed 12 (17%) spontaneous abortions, one ectopic preg (1%) and 3 (4%) stillbirths. Interferon alpha was used in 12 high risk cases with 10 live births (83%) and 2 spontaneous abortions. Concerning maternal complications, the rate of severe thromboembolic events was similar between the two groups (group 1: one pulmonary embolism with cardiogenic shock (2,6%), group 2: two Budd Chiari syndromes in 3rd trimester (2,8%). There were no deaths. Of note, the bleeding rate was significantly higher in group 2 (8 minor and 3 major bleedings) which was probably due to the treatment with aspirin and low molecular weight heparin in this group while only one minor bleeding was observed in group 1 [chi square, p = 0,036]. Most PV patients’ hematocrit values spontaneously decreased during preg, thus phlebotomies were mainly performed during the first trimester. 6 twin pregs were managed in group 2, five of them resulted in live births, and one patient had a spontaneous abortion in the 22th week.
Conclusion
This is the largest series of PV pregs reported to date collected across the European LeukemiaNet network. The success rate of pregs was significantly better (49% versus 77%, respectively) for patients in whom the diagnosis of PV was known and appropriate management performed according to current guidelines. This high success rate of almost 80% is encouraging in this higher risk PV population. However, despite the use of aspirin and molecular weight heparin major thrombotic events still occur and an increased bleeding rate is observed.
Session topic: Myeloproliferative neoplasms - Clinical 1
Keyword(s): Polycythemia vera, Pregnancy
Type: Oral Presentation
Presentation during EHA21: On Friday, June 10, 2016 from 11:30 - 11:45
Location: Auditorium 1
Background
Very limited data are available regarding pregnancy (preg) outcomes in patients with PV, less than 40 pregs being reported in the literature. Within the European LeukemiaNet we collected 121 pregs in 48 PV patients from 7 centers in France, Italy, Serbia, Romania, Switzerland and Germany.
Aims
Outcomes of pregancies in patients with polycythemia vera (PV).
Methods
Pregs were categorized in two groups. Group 1 consisted of pregs before the diagnosis of PV (n=39). Group 2 (n=82) included all pregs after the diagnosis of PV. Most patients in group 2 received low dose aspirin during preg and low molecular weight heparin after delivery until the 6th week postpartum. The target hematocrit during preg was 40% and therapeutic phlebotomy was performed, if needed. Iron supplementation was not advised during preg.
Results
Median age at diagnosis of PV was 29 yrs (range 18-40), median age at delivery 32 yrs (21-43). 13 out of 48 patients (27%) had high-risk PV due to severe thromboembolic complications either at the time of diagnosis or during follow up. These included 5 Budd Chiari syndromes, 4 portal vein thromboses, 2 superior sagittal sinus thromboses, 3 deep vein thromboses, and one pulmonary embolism. In group 2, a planned medical interruption was performed in 6/82 pregs due to patients´ choice. The outcome of another 6 pregs cannot be reported yet (still ongoing in 3 and missing in another 3). Thus, a total of 70 pregs are evaluable at time of abstract submission in group 2.In group 1 live birth was recorded in 19/39 pregs (49%), while 20 pregs were unsuccessful due to spontaneous abortion (n=9; 23%), stillbirth (n=8; 21%) or late fetal loss (n=3; 8%). In contrast, outcome was significantly better in group 2 with 54 live births out of 70 pregs (77%) [chi square, p = 0,002]. In group 2 we observed 12 (17%) spontaneous abortions, one ectopic preg (1%) and 3 (4%) stillbirths. Interferon alpha was used in 12 high risk cases with 10 live births (83%) and 2 spontaneous abortions. Concerning maternal complications, the rate of severe thromboembolic events was similar between the two groups (group 1: one pulmonary embolism with cardiogenic shock (2,6%), group 2: two Budd Chiari syndromes in 3rd trimester (2,8%). There were no deaths. Of note, the bleeding rate was significantly higher in group 2 (8 minor and 3 major bleedings) which was probably due to the treatment with aspirin and low molecular weight heparin in this group while only one minor bleeding was observed in group 1 [chi square, p = 0,036]. Most PV patients’ hematocrit values spontaneously decreased during preg, thus phlebotomies were mainly performed during the first trimester. 6 twin pregs were managed in group 2, five of them resulted in live births, and one patient had a spontaneous abortion in the 22th week.
Conclusion
This is the largest series of PV pregs reported to date collected across the European LeukemiaNet network. The success rate of pregs was significantly better (49% versus 77%, respectively) for patients in whom the diagnosis of PV was known and appropriate management performed according to current guidelines. This high success rate of almost 80% is encouraging in this higher risk PV population. However, despite the use of aspirin and molecular weight heparin major thrombotic events still occur and an increased bleeding rate is observed.
Session topic: Myeloproliferative neoplasms - Clinical 1
Keyword(s): Polycythemia vera, Pregnancy
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