title: Outcome of pregnancy and disease course among women with aplastic anemia treated with immunosuppression.
abstract: BACKGROUND
  Aplastic anemia may develop during pregnancy and sometimes improves spontaneously after delivery. The effects of pregnancy on aplastic anemia after immunosuppressive treatment and of aplastic anemia on the outcome of pregnancy have not been described.
  
  
  OBJECTIVE
  To determine the outcome of pregnancy and the disease course among women with aplastic anemia who received immunosuppressive therapy.
  
  
  METHODS
  Retrospective multicenter study.
  
  
  METHODS
  Twelve centers participating in the European Group for Blood and Marrow Transplantation.
  
  
  METHODS
  36 women who received immunosuppressive therapy to treat aplastic anemia.
  
  
  METHODS
  Outcomes of pregnancy and aplastic anemia and blood counts before, during, and after delivery.
  
  
  RESULTS
  The 36 pregnancies resulted in 34 live births (one set of twins), 2 elective abortions, and 1 spontaneous abortion. Of the 36 pregnancies, 22 were uncomplicated and 14 involved medical complications. Seven pregnancies (19%) were complicated by relapse of aplastic anemia, and 5 patients without relapse (14%) needed transfusions during delivery. After delivery, 3 of the 7 patients who had relapse recovered spontaneously and 3 recovered after retreatment. One patient who did not respond to treatment died of aplastic anemia. A woman with aplastic anemia and paroxysmal nocturnal hemoglobinuria had a fatal cerebral thrombosis after delivery. Women with uneventful pregnancies had better prepregnancy remission status (8 complete and 11 partial remissions) and a higher median platelet count (146 x 10(9) cells/L) than did women with complicated pregnancies (2 complete remissions, 8 partial remissions, and 4 cases of paroxysmal nocturnal hemoglobinuria; median platelet count, 92 x 10(9) cells/L).
  
  
  CONCLUSIONS
  Successful pregnancy with normal outcome is possible in women with aplastic anemia previously treated with immunosuppression. Complications appear to be more likely in patients with low platelet counts and paroxysmal nocturnal hemoglobinuria-associated aplastic anemia.
authors.affiliation: University Hospitals Basel, Hematology, Petersgraben 4, CH-4031 Basel, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Tichelli
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Judith
authors.initials: J
authors.lastname: Marsh
authors.forename: Renée
authors.initials: R
authors.lastname: Barge
authors.forename: Norbert
authors.initials: N
authors.lastname: Frickhofen
authors.forename: Shaun
authors.initials: S
authors.lastname: McCann
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Jill
authors.initials: J
authors.lastname: Hows
authors.forename: Pedro
authors.initials: P
authors.lastname: Marin
authors.forename: David
authors.initials: D
authors.lastname: Nachbaur
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Hubert
authors.initials: H
authors.lastname: Schrezenmeier
mesh_terms: D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000188:drug therapy*; D001772:Blood Cell Count; D005260:Female; D006452:Hemoglobinometry; D006457:Hemoglobinuria, Paroxysmal / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011256:Pregnancy Outcome; D012074:Remission Induction; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents