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Outcome of Pregnancy and Disease Course among Women with Aplastic Anemia Treated with Immunosuppression

André Tichelli, MD; Gérard Socié, MD, PhD; Judith Marsh, MD; Renée Barge, MD; Norbert Frickhofen, MD; Shaun McCann, MD; Andrea Bacigalupo, MD; Jill Hows, MD; Pedro Marin, MD, PhD; David Nachbaur, MD; Argiris Symeonidis, MD; Jakob Passweg, MD; Hubert Schrezenmeier, MD, European Group for Blood and Marrow Transplantation Severe Aplastic Anaemia Working Party*
[+] Article and Author Information

From University Hospitals Basel, Basel, Switzerland; Hôpital St. Louis, Paris, France; St. George's Hospital, London, and Bristol Haematology and Oncology Centre, Bristol, United Kingdom; Dr. Horst-Schmidt-Kliniken, Wiesbaden, and Freien Universität Berlin, Berlin, Germany; St. James Hospital, Trinity College, Dublin, Ireland; Ospedale San Martino, Genoa, Italy; Instituto de Investigaciones Biomédicas Agustí Pi Sunyer, Barcelona, Spain; University Hospital Innsbruck, Innsbruck, Austria; and Patras University Medical School, Patras, Greece.


Acknowledgments: The authors thank the study patients and their referring physicians. They also thank Alois Gratwohl for critical review of the manuscript.

Requests for Single Reprints: André Tichelli, MD, University Hospitals Basel, Hematology, Petersgraben 4, CH-4031 Basel, Switzerland.

Current Author Addresses: Drs. Tichelli and Passweg: University Hospitals Basel, Hematology, Petersgraben 4, CH-4031 Basel, Switzerland.

Dr. Socié: Hôpital St. Louis, Department of Hematology, Bone Marrow Transplantation, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.

Dr. Marsh: St. George's Hospital, Medical School, Department of Cellular and Molecular Sciences, Division of Haematology, Crammer Terrace, London SW17 ORE, United Kingdom.

Dr. Barge: Bone Marrow Transplantation Centre Leiden, Leiden University Hospital, PO Box 9600, 2300 RC Leiden, the Netherlands.

Dr. Frickhofen: Dr. Horst-Schmidt-Kliniken, Department of Medicine III, Hematology/Oncology, 65199 Wiesbaden, Germany.

Dr. McCann: St. James Hospital, Department of Hematology, Trinity College, James Street, Dublin 8, Ireland.

Dr. Bacigalupo: Ospedale San Martino, Department of Hematology, Viale Benedetto XV, 16132 Genoa, Italy.

Dr. Hows: Bristol Haematology and Oncology Centre, Avon Haematology Unit, Horfield Road, Bristol BS2 8ED, United Kingdom.

Dr. Marin: Instituto de Investigaciones Biomédicas Agustí Pi Sunyer, Hemotherapy and Hemostasis Department, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain.

Dr. Nachbaur: University Hospital Innsbruck, Division of Hematology and Oncology, Anichstrasse 35, 6020 Innsbruck, Austria.

Dr. Symeonidis: Patras University Medical School, Hematology Division, Department of Internal Medicine, University Hospital, 261 10 Patras, Greece.

Dr. Schrezenmeier: Klinikum Benjamin Franklin, der Freien Universität Berlin, Innere Medizin, Hämatologie/Onkologie, Hindenburgdamm 30, 12200 Berlin, Germany.

Author Contributions: Conception and design: A. Tichelli, G. Socié, J. Passweg, H. Schrezenmeier.

Analysis and interpretation of the data: A. Tichelli.

Drafting of the article: A. Tichelli, G. Socié, J. Passweg, H. Schrezenmeier.

Critical revision of the article for important intellectual content: A. Tichelli, G. Socié, J. Marsh, R. Barge, N. Frickhofen, S. McCann, A. Bacigalupo, J. Hows, P. Marin, D. Nachbaur, A. Symeonidis, J. Passweg, H. Schrezenmeier.

Final approval of the article: A. Tichelli, G. Socié, J. Marsh, R. Barge, N. Frickhofen, S. McCann, A. Bacigalupo, J. Hows, P. Marin, D. Nachbaur, A. Symeonidis, J. Passweg, H. Schrezenmeier.

Provision of study materials or patients: A. Tichelli, G. Socié, J. Marsh, R. Barge, N. Frickhofen, S. McCann, A. Bacigalupo, J. Hows, P. Marin, D. Nachbaur, A. Symeonidis, J. Passweg, H. Schrezenmeier.

Statistical expertise: A. Tichelli, J. Passweg.

Collection and assembly of data: A. Tichelli.


Ann Intern Med. 2002;137(3):164-172. doi:10.7326/0003-4819-137-3-200208060-00008
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Our data suggest that successful pregnancy is possible after treatment of aplastic anemia with immunosuppression. More than 50% of the pregnancies were uneventful. Nevertheless, complications in the mothers and infants were common and were often related to the aplastic anemia. One third of the patients became transfusion dependent during pregnancy, and 19% experienced relapse of aplastic anemia. In most cases, women with relapsed aplastic anemia or progressive thrombocytopenia during pregnancy had cesarean section. Most patients with relapse recovered spontaneously or after repeated immunosuppressive therapy. We observed two deaths that were possibly related to pregnancy.

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Figure 1.
Complications in participants during first pregnancy, at delivery, and after delivery.

The outcome of 11 subsequent pregnancies in 9 women are not shown. Numbers in parentheses are numbers of patients. ATG = antithymocyte globulin. *Indicates patients who had paroxysmal nocturnal hemoglobinuria before conception. This applies to only 1 of the 3 patients with spontaneous remission.

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Figure 2.
Hemoglobin concentration and neutrophil and platelet counts before, during, and after first pregnancy.Top.Middle.Bottom.

Hemoglobin concentration. Neutrophil count. Platelet count. Bars represent 75% CIs.

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Summary for Patients

Pregnancy Outcomes in Women with Aplastic Anemia Treated with Immunosuppression

The summary below is from the full report titled “Outcome of Pregnancy and Disease Course among Women with Aplastic Anemia Treated with Immunosuppression.” It is in the 6 August 2002 issue of Annals of Internal Medicine (volume 137, pages 164-172). The authors are A Tichelli, G Socié, J Marsh, R Barge, N Frickhofen, S McCann, A Bacigalupo, J Hows, P Marin, D Nachbaur, A Symeonidis, J Passweg, and H Schrezenmeier, for the European Group for Blood and Marrow Transplantation Severe Aplastic Anaemia Working Party.

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