Pregnancy Outcomes after Hematopoietic Cell Transplantation (HCT): A Report from the BMT Survivor Study.

Abstract

Infertility after HCT is a common complication. However, there are some reports indicating that a few patients may retain or recover fertility after HCT. This study was undertaken to determine the prevalence of conception, and outcome of pregnancy in 581 adult women and female partners of men previously treated by autologous (n=234) or allogeneic (n= 347) HCT. Eligible subjects were individuals who had undergone HCT between 1974 and 1998, were transplanted between the ages of 21 and 45, and had survived two or more years after HCT. Median age at HCT was 33.3 years (range, 21.0–44.9), median time since HCT: 7.5 (2.0–24.4). Methodology involved completion of a mailed questionnaire that included items regarding attempts to become pregnant, the occurrence of pregnancy, and the outcome of pregnancy (i.e., live birth, stillbirth, miscarriage, abortion). We abstracted details about the original diagnosis, type of HCT, myeloablative conditioning, and development of chronic graft vs. host disease (cGVHD) from medical records. Twenty-eight patients (4.8%) reported 47 pregnancies after HCT (17 allogeneic and 11 autologous HCT recipients). Of these, 21 males reported 34 pregnancies, while 7 females reported 13 pregnancies. Most pregnancies were uncomplicated and resulted in 40 live births. Risk factors associated with not reporting a conception after HCT included age 30 years or older at time of transplant (odds ratio [OR] = 3.26, 95% confidence interval [CI], 1.20–8.85) and exposure to total body irradiation (TBI) as part of HCT conditioning regimen (OR = 3.84; 95% CI, 1.42–10.34). Risk did not vary significantly by gender, ethnicity, type of transplant, cGVHD status, report of pre-HCT live birth(s), exposure to immunosuppressive agents for GVH prophylaxis or high-dose chemotherapy as conditioning agents. Pregnancy outcomes among the survivors were compared to those of 309 nearest-age siblings who were between the ages of 21 and 45 years at the time of their reported pregnancies. This comparison revealed that the risk for not reporting a conception was significantly increased among HCT recipients (OR = 41.25, 95% CI, 25.83–65.88) and among those with low annual household income (<$20,000: OR=4.45, 95% CI, 1,52–12.99). The outcomes of the 47 pregnancies reported by 28 survivors and those of the 556 pregnancies reported by 215 siblings are shown in the table. Analyses of pregnancy outcomes in this cohort indicated that HCT survivors were more likely than siblings to have a live birth (OR=2.72, 95% CI, 1.05–7.02), and that survivors were not significantly more likely than siblings to have a miscarriage or stillbirth outcome (RR=0.55, 95% CI, 0.21–1.42). This study indicates that conception after HCT is likely to have a successful outcome, although the prevalence of pregnancy after HCT is significantly diminished, especially among patients undergoing HCT at an older age, among those exposed to TBI, and among those with a low household income. These findings should help counsel the patients undergoing HCT.Pregnancy OutcomesNumber of ConceptionsLive BirthStillbirthMiscarriageAbortionIn gestationSurvivors (n=47)40 (85%)1 (2%)4 (9%)02 (4%)Siblings (n=556)413 (74%)6 (1%)94 (17%)37 (7%)6 (1%)