Stem cell transplant recipients can have successful pregnancies

Some women can become pregnant and give birth to healthy children after undergoing stem cell transplantation, according to a retrospective study.

Allogeneic haematopoietic stem cell transplantation (alloHCT) – commonly referred to as a 'bone marrow transplant' – is when a person's blood-forming stem cells are replaced with ones from a donor, usually in the attempt to cure a serious illness such as leukaemia or sickle cell disease. Before the patient can receive the new cells, their old stem cells are typically destroyed using chemotherapy or radiotherapy which can also affect fertility.

'Fertility is a very important topic for young female patients,' said the study's lead author Dr Katja Sockel, a senior physician at University Hospital Carl Gustav Carus in Dresden, Germany. 'Some patients even opt out of receiving certain treatments because of concerns about fertility. For young adult cancer survivors especially, the return to a normal life includes family planning.'

Dr Sockel and her colleagues conducted a systemic retrospective study on women who underwent alloHCT between the ages of 18 to 40. Publishing their findings in Blood, the researchers found that among 2654 participants, 50 women became pregnant on average within five years from the transplant. Almost three-quarters of the recorded pregnancies were spontaneous, while the rest were achieved using fertility treatment.

'Some study participants reported that they had not taken measures to prevent pregnancy because their doctor told them conception was not possible,' said Dr Sockel. 'Spontaneous pregnancies should not be underestimated, and female patients should be educated about potential fertility restoration post-alloHCT to prevent unplanned or unwanted pregnancies.'

Women treated with alloHCT were also found to be more likely to give birth prematurely and to have babies of lower weight than the general population. However, women who were treated for non-cancerous blood disorders, such as sickle cell disease, or were exposed to low or no radiotherapy, had a greater chance of becoming pregnant than other study participants.

'The results of this study show that female alloHCT recipients can achieve successful and safe pregnancies,' Dr Sockel said. ‘These findings help provide a basis for counselling young women of childbearing age and raising awareness of and funding for different assisted reproductive technologies techniques so that patients can have a normal life after alloHCT.'

The findings may also be relevant for patients receiving certain types of gene therapy where their own stem cells are edited outside the body and then transplanted back, such as two that have been approved by the US Food and Drug Administration for the treatment of sickle cell disease (see BioNews 1220).