Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation
Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation
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DOI：
10.1182/blood.v87.7.3045.bloodjournal8773045
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发表时间：
1996-04-01
期刊：
影响因子：
20.3
通讯作者：
Appelbaum, FR
中科院分区：
文献类型：
--
作者：
Sanders, JE;Hawley, J;Appelbaum, FR
成功接受骨髓移植的患者通常会担心生育和怀孕。本研究的目的是确定接受大剂量化疗单独或全身照射（TBI）和骨髓移植治疗再生障碍性贫血或恶性血液病的患者的妊娠结局。本文回顾了1971年8月至1992年1月在西雅图进行骨髓移植的1,326例青春期后和196例青春期前患者的记录，以确定性腺功能正常和妊娠的患者。708例青春期后妇女中，110例恢复正常卵巢功能，32例妊娠。此外，9名性腺功能正常的青春期前女孩怀孕了。在618名青春期后男性中，157名睾丸功能恢复，33名男性的伴侣怀孕。另外两名前青春期男性的伴侣怀孕了。41名女性患者和35名男性患者的伴侣在移植后妊娠146次。所有76例患者均回答了一份问卷，要求提供所有临床确认妊娠的妊娠史、结局、婴儿出生体重和先天性异常信息。146例妊娠中有115例活产（79%）。自然流产终止了28名女性环磷酰胺（CY）受体的56例妊娠中的4例（7%）和13名TBI受体的16例妊娠中的6例（37%）（P =.02）。28例男性CY受者的配偶有4/62例（6.4%）妊娠终止自然流产，但5例TBI受者的配偶有8例妊娠终止自然流产。早产发生8 44（18%）和5 8（63%）活产24 CY和8 TBI女性收件人（P = 0.01）。在所有女性患者妊娠中，25%的发生率高于8%至10%的预期发生率（P = 0.0001）。13例早产导致10例低出生体重（[LBW] 1.8 - 2.24 kg）和3例极低出生体重（[VLBW]小于或等于1.36 kg）婴儿，总发生率为25%，高于一般人群的预期发生率6.5%（P =.0001）。13名早产儿中有12人存活。52例中有2例存在先天性畸形，（3.8%）活产婴儿的女性和6 63（9.5%）男性患者的活产婴儿，这与一般人群报告的13%的单一先天性异常没有区别，这些数据表明，接受了合并TBI的骨髓移植的妇女中临床公认的妊娠可能伴随着TBI。增加自然流产的风险。所有接受骨髓移植的妇女的妊娠可能伴有早产和分娩LBW或VLBW婴儿，这些婴儿似乎没有先天性异常的风险增加。然而，确定父母暴露于高剂量烷化剂（伴或不伴TBI）对移植后出生的儿童可能产生的不良影响需要更长时间的额外随访。(C)1996年，美国血液学会。
Patients successfully treated with a marrow transplant often have concerns about fertility and pregnancy. This study was performed to determine pregnancy outcome among patients who had received high-dose chemotherapy alone or with total-body irradiation (TBI) and marrow transplantation for aplastic anemia or hematologic malignancy. Records of 1,326 postpubertal and 196 prepubertal patients currently more than 12 years of age after marrow transplant in Seattle from August 1971 to January 1992 were reviewed to determine the patients with normal gonadal function and pregnancies. Among 708 postpubertal women, 110 recovered normal ovarian function and 32 became pregnant. In addition, nine formerly prepubertal girls with normal gonadal function became pregnant. Among 618 postpubertal men, 157 recovered testicular function and partners of 33 became pregnant. An additional two formerly prepubertal men had partners who became pregnant. Forty-one female patients and partners of 35 male patients had 146 pregnancies after transplant. All 76 patients responded to a questionnaire requesting pregnancy history, outcome, infant birth weight, and congenital anomalies information for all clinically recognized pregnancies. There were 115 live births among 146 (79%) pregnancies. Spontaneous abortion terminated four of 56 (7%) pregnancies for 28 female cyclophosphamide (CY) recipients and six of 16 (37%) pregnancies for 13 TBI recipients (P = .02). Partners of 28 male CY recipients had four of 62 (6.4%) pregnancies terminate with spontaneous abortion, but there were no spontaneous abortions among eight pregnancies of five TBI recipients' partners. Preterm delivery occurred for eight of 44 (18%) and five of eight (63%) live births for 24 CY and eight TBI female recipients (P = .01). This 25% incidence among all female patient pregnancies is higher than the expected incidence of 8% to 10% (P = .0001). The 13 preterm deliveries resulted in 10 low birth weight ([LBW] 1.8 to 2.24 kg) and three very low birth weight ([VLBW] less than or equal to 1.36 kg) infants, for an overall incidence of 25%, which is higher than the expected incidence of 6.5% for the general population (P = .0001). Twelve of the 13 premature infants survive. Congenital anomalies were seen among two of 52 (3.8%) live-born infants of female and six of 63 (9.5%) live-born infants of male patients, which is not different from the 13% of single congenital anomalies reported for the general population, These data demonstrate that clinically recognized pregnancies among women who have received a marrow transplant incorporating TBI are likely to be accompanied by an increased risk of spontaneous abortion. Pregnancies among all women who received a marrow transplant are likely to be accompanied by preterm labor and delivery of LBW or VLBW babies who do not seem to be at an increased risk of congenital anomalies. However, determination of possible adverse effects of parental exposure to high-dose alkylating agents with or without TBI on children born posttransplant requires longer, additional follow-up. (C) 1996 by The American Society of Hematology.