Interferon alpha for essential thrombocythemia during 34 high-risk pregnancies: outcome and safety
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ORIGINAL ARTICLE – CLINICAL ONCOLOGY
Interferon alpha for essential thrombocythemia during 34 high‑risk pregnancies: outcome and safety Lukas Schrickel1 · Florian H. Heidel2,3 · Parvis Sadjadian1 · Tatjana Becker1 · Vera Kolatzki1 · Andreas Hochhaus2 · Martin Griesshammer1 · Kai Wille1 · For the German Study Group MPN, GSG-MPN Received: 10 August 2020 / Accepted: 8 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Pregnancies in women with essential thrombocythemia (ET) are at a higher risk for obstetrical complications. Acetylsalicylic acid (ASA) and low-molecular weight heparin (LMWH) are common options to prevent miscarriages and maternal complications, whereas interferon alpha (IFN) seems to be the cytoreductive therapy of choice. This retrospective study analyzes the largest number of IFN pregnancies to date in terms of outcome and safety. Methods Data of 34 high-risk pregnancies in 23 women presenting at the University hospitals of Minden and Jena from 01-Jun-2007 to 01-Jun-2020 were collected. Reasons defining high-risk ET pregnancy in all 23 patients were: Thrombosis (n = 9) or severe hemorrhage (n = 2) in history, platelet count ≥ 1500 × 103/µl (n = 8) or severe microcirculatory disturbances not completely responding to ASA (n = 4). Results Without the use of IFN, live birth rate was 60% (6/10), however, after the use of IFN live birth rate increased to 73.5% (25/34 pregnancies). Nine pregnancies ended in miscarriages (9/34; 26.5%); all of them spontaneous abortions. Live birth rate significantly improved with ASA (90% versus 50%, p = 0.0168), however, if ASA and LMWH was added (n = 14), live birth rate was 100%. IFN compound (PEGylated versus standard IFN) and JAK2-driver mutation had no impact on pregnancy outcome. One major maternal complication occurred as a major peripartal bleeding after abortion curettage. Conclusion IFN was associated with an encouraging live birth rate of 73.5% with no fatal maternal events and manageable side effects. Keywords Essential thrombocythemia · Pregnancies · Interferon alpha · Outcome · Safety
Introduction Essential thrombocythemia (ET) is one of the three common BCR-ABL1-negative myeloproliferative neoplasms (MPN) with an incidence of 0.38–1.7 per 100.000 persons. It is associated with an increased risk of thromboembolic, hemorrhagic or microcirculatory disturbances (Tefferi * Lukas Schrickel [email protected] 1
University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, UKRUB, Ruhr-University Bochum, Minden, Germany
2
Department of Internal Medicine 2, Haematology and Oncology, University Hospital Jena, Jena, Germany
3
Internal Medicine C, University Medicine Greifswald, Greifswald, Germany
et al. 2014). Although peak incidence of ET is at older age, about 20% of all patients are younger than 40 years. This includes women of fertile age with the management problem of ET during pregnancy to prevent miscarriages and mat
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