Clinical analysis of essential thrombocythemia and pregnancy: treatment and outcomes

Abstract

Objectives To summarize the maternal and fetal outcomes of patients with essential thrombocythemia (ET), and tentatively propose possible solutions for different clinical scenarios. Methods We retrospectively studied the clinical data, treatment, outcomes and follow-up status in 18 consecutive cases of young women with ET visited Peking University People's Hospital, among whom 22 pregnancies occurred from March 2005 to January 2015. Rank-sum test, Chi-square test or Fisher exact test were applied for statistics. Results (1) Out of the total 22 pregnancies, 17 (77%) were successful (term live births) and five (23%) ended in miscarriages, among which four were spontaneous abortion in first trimester. (2) Six pregnancies did not received any therapy, while 16 received various treatments before and/or during pregnancy, including oral Aspirin(single/joint), Hydroxyurea, Interferon-α(IFN-α) and platelet apheresis. (3) Treatments before/during pregnancy improved the live birth rate significantly (15/16 vs 2/6, P=0.009). Platelet (PLT) count of the newborns were all normal till the time at follow-up. (4) The median PLT count in those patients before Aspirin therapy was 761×109/L[ (448-1 213) ×109/L, and 639×109/L[ (283-1 908) ×109/L] thereafter, which showed no significant difference (Z=-0.405, P=0.686) . (5) The PLT counts in those patients before combination therapy of Aspirin and IFN-α was 989×109/L[ (435-1 504) ×109/L], and 498×109/L[ (186-559) ×109/L] thereafter, which decreased significantly (Z=-2.366, P=0.018). Conclusions (1) First-trimester spontaneous abortion is the most common complication of ET in pregnancy. (2) A specific treatment strategy may improve the pregnant outcomes without long-term harmful effect up to now. (3) IFN-α and/or Aspirin might be the first-line therapy in women with ET during pregnancy. Key words: Pregnancy complications, hematologic; Thrombocythemia, essential; Aspirin; Interferon-alpha; Pregnancy outcome