Outcome of 122 pregnancies in essential thrombocythemia patients: A report from the Italian registry

Melillo, Lorella; Tieghi, Alessia; Candoni, Anna; Radaelli, Franca; Ciancia, Rosanna; Specchia, Giorgina; Martino, Bruno; Scalzulli, Potito Rosario; Latagliata, Roberto; Palmieri, Fausto; Usala, Emilio; Valente, Daniela; Valvano, Maria Rosa; Cedrone, Michele; Comitini, Giuseppina; Martinelli, Vincenzo; Cascavilla, Nicola; Gugliotta, Luigi

doi:10.1002/ajh.21504

Cited by 80 publications

(89 citation statements)

References 25 publications

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“…73 The pathogenesis of these complications is unclear; age, parity, thrombophilia, PLT count, WBC count, and hemoglobin level have not been found to be predictive of pregnancy outcome in ET. [74][75][76] Whether the use of aspirin can improve pregnancy outcome is uncertain [74][75][76][77] ; however, a meta-analysis of randomized trials conducted outside ET concluded that low-dose aspirin is effective in preventing preeclampsia, being safe for both mother and fetus. 78 Pregnancy complications in women with ET are associated with a higher risk of subsequent thrombosis.…”

Section: Distinguishing Familial Et From Hereditary Thrombocytosismentioning

confidence: 99%

How I treat essential thrombocythemia

Rumi

Cazzola

2016

Blood

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Essential thrombocythemia (ET) is an indolent myeloproliferative neoplasm that may be complicated by vascular events, including both thrombosis and bleeding. This disorder may also transform into more aggressive myeloid neoplasms, in particular into myelofibrosis. The identification of somatic mutations of JAK2, CALR, or MPL, found in about 90% of patients, has considerably improved the diagnostic approach to this disorder. Genomic profiling also holds the potential to improve prognostication and, more generally, clinical decision-making because the different driver mutations are associated with distinct clinical features. Prevention of vascular events has been so far the main objective of therapy, and continues to be extremely important in the management of patients with ET. Low-dose aspirin and cytoreductive drugs can be administered to this purpose, with cytoreductive treatment being primarily given to patients at high risk of vascular complications. Currently used cytoreductive drugs include hydroxyurea, mainly used in older patients, and interferon α, primarily given to younger patients. There is a need for disease-modifying drugs that can eradicate clonal hematopoiesis and/or prevent progression to more aggressive myeloid neoplasms, especially in younger patients. In this article, we use a case-based discussion format to illustrate our approach to diagnosis and treatment of ET.

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Section: Distinguishing Familial Et From Hereditary Thrombocytosismentioning

confidence: 99%

How I treat essential thrombocythemia

Rumi

Cazzola

2016

Blood

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“…Anecdotal use of Peg-IFNa in pregnant patients with hepatitis or myeloproliferative disorders (including ET) has been reported with encouraging results concerning safety and disease remission [53][54][55][56][57].…”

Section: Pegylated Interferon-amentioning

confidence: 99%

Patients with essential thrombocytosis during pregnancy: Challenges and therapeutic dilemmas

Kanellopoulou¹

2017

Obstet Gynecol Rep

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Treatment of patients with essential thrombocytosis during pregnancy is challenging and young women are reported to be at increased risk of first trimester abortions and other pregnancy complications. In literature, there are case reports and small case series where the treatment approach differs and the results are conflicting. The addition of low dose aspirin seems to be beneficial in most cases improving pregnancy outcome whereas interferon-a is the cytoreductive drug of choice when platelet control is needed during pregnancy. Anticoagulation with low-molecular weight heparin is not generally recommended and should be considered during the last few weeks of pregnancy and postpartum.

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“…7 The benefit of low-dose aspirin (ASA) is contradictory, with some studies suggesting a reduction of miscarriage in treated patients 6 and others not. 8 However, safety of ASA in this population is well established.…”

mentioning

confidence: 99%

“…However, one retrospective study reported safety for IFN-treated pregnant patients with an increase in live birth rate, 8 and current recommendations consider IFN as a reasonable treatment.…”

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confidence: 99%