Pregnancy following Bone Marrow Transplant

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Key points

  • Survival from childhood cancers is >80% with increasing numbers of female childhood cancer survivors of reproductive age subsequently conceiving.
  • There is an increased risk of adverse pregnancy outcomes in childhood and young adult cancer survivors.
  • Little is currently known about pregnancy management and outcomes in women who conceived following bone marrow transplant.

Surveillance period

1st January 2020 – 31st December 2021

Background

With improved survival rates and assisted reproductive techniques, such as IVF, an increasing number of women are conceiving who had cancer treatment as a child or young adult[1]. Childhood and young adult cancer survivors are at increased risk of adverse pregnancy outcomes, including preterm birth (particularly if they have had pelvic or abdominal radiation). The importance of late effects of cancer treatment on reproductive outcomes is increasingly recognised, however data on pregnancy complications and outcomes following bone marrow transplant is sparse[1][2][3][4]. It is thought that having had a bone marrow transplant will cause a particularly high risk of a) problems with the immune system and b) radiation damage to the uterus. It is hoped this study will inform future guidance and recommendations on preventing adverse pregnancy outcomes in women who have conceived following bone marrow transplant.

Objective

To use the UK Obstetric Surveillance System (UKOSS) to determine the incidence, risk factors and outcomes of pregnancy in women who become pregnant after bone marrow transplant.

Research questions

  • What is the incidence of women conceiving after bone marrow transplant?
  • What is the rate of adverse pregnancy outcomes in women who conceive following bone marrow transplant?
  • How are pregnant women who have received a bone marrow transplant prior to pregnancy managed in the UK?
  • Is bone marrow transplant a risk factor for preterm birth, independent of total body irradiation?
  • What are the maternal and neonatal outcomes of pregnancy in women who become pregnant after bone marrow transplant?

Case definition

Any woman who has a pregnancy following bone marrow transplantation, with or without total body irradiation. Please report all women with a pregnancy, irrespective of the pregnancy outcome (eg. Miscarriage, termination, stillbirth, live birth). Please report all women who give birth or whose pregnancy ends between 01/01/2020 and 31/12/2021.

Funding

This study is being funded by Action Medical Research & Borne.

Ethics committee approval

This study has been approved by the North London REC1 (Ref. Number: 10/H0717/20).

Lead investigators

Dr Melanie J Griffin, Dr Kate Birchenall, University Hospitals Bristol NHS Foundation Trust and University of Bristol; Prof Anna David, Dr Melanie Davies and Dr Victoria Grandage, University College London; Prof Mike Hawkins and Dr Raoul Reulen, University of Birmingham.

References

  1. a, b Reulen RC, Bright CJ, Winter DL et al. Pregnancy and Labour Complications in Female Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study. J Natl Cancer Inst. 2017;109(11).
  2. ^ Sekiguchi M, Miyoshi Y, Kikuchi N, Sago H. Pregnancy outcomes in female childhood cancer survivors: Nationwide survey in Japan. Pediatr Int. 2018:60(3):254-258.
  3. ^ Sanders JE, Hawley J, Levy W et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood. 1996;87(7):3045-3052.
  4. ^ Salooja N, Szydlo RM, Socie G et al. Pregnancy outcomes after peripheral blood or bone marrow transplantation: a retrospective survey. Lancet. 2001;358(9278):271-276.

Updated: Monday, 20 January 2020 13:25 (v4)