Pregnancy outcome following hematopoietic cell transplantation for thalassemia major

Pregnancy outcome following hematopoietic cell transplantation for thalassemia major
Hematopoietic stem cell transplantation (HSCT) offers a definitive cure for patients with β–thalassemia major at the expense of permanent infertility as a consequence of this treatment modality. This study follows the course and outcomes of pregnancies of β-thalassemia female patients and partners of male patients who were successfully treated with allogeneic HSCT.
The methods of conception and delivery, course and outcomes of 42 post-transplant pregnancies occurring in 15 female patients and partners of 8 male patients with β–thalassemia major who were successfully treated with allogeneic HSCT in a single center from Italy were investigated. All patients received myeloablative conditioning with busulfan and cyclophosphamide (200 mg/kg), and treated with cyclosporine and methotrexate for GVHD prophylaxis.
In the female patients, 9 of the 15 patients (60%) needed post-transplant hormonal supplementation to restore normal menses. Twenty-one pregnancies (78%) were achieved with spontaneous conception in 11 women. Six pregnancies were achieved in 4 women following either in vitro fertilization and embryo transfer or heterologous ovo-donation. There were two cases of miscarriage, a high rate of complications (59%) and a remarkably high (22.7%) rate of preterm delivery. Delivery by cesarean section was observed in 18 of the 22 pregnancies (82%).
The partners of the male transplanted patients had uncomplicated pregnancies. Conception was spontaneous and natural in all cases and was followed by uncomplicated outcome with normal gestational age at birth and no miscarriage.
This study describes a small fortunate group of patients who successfully achieved pregnancy post HSCT but the actual fertility of this patient group cannot be estimated as the proportion of patients trying to get pregnant is unknown.
Some β–thalassemia major patients post allogeneic HSCT retain or recover their fertility after transplant at the expense of an excess in complications and preterm delivery.