Pregnancy post autologous stem cell transplant with BEAM conditioning for multiple sclerosis

Abstract

Background: Given the increasing numbers of multiple sclerosis (MS) patients undergoing autologous haematopoietic stem cell transplant (AHSCT) worldwide, and with women of childbearing age overrepresented in the target population, it is increasingly important to review fertility and pregnancy outcomes following AHSCT. Objective: To evaluate the rate of pregnancy and complications post-AHSCT for MS. Method: Retrospective evaluation of the rate of pregnancy and associated complications in a cohort of patients post-AHSCT with BEAM conditioning for MS since 2010 in a tertiary referral centre. Results: In our ongoing Phase 2 trial of AHSCT for MS, 55 patients have undergone AHSCT with 30 females being of childbearing age at time of transplantation. Four pregnancies occurred following AHSCT. Two pregnancies were carried to term. No maternal or neonatal complications were reported in either case. Two pregnancies were not carried to term due to elective terminations. Both of these patients became pregnant unexpectedly 2 years following AHSCT. Of the 21 male patients, one patient has fathered three children since his AHSCT. There were no newborn complications. Conclusions: This is the first report to our knowledge on fertility outcomes in both sexes post-AHSCT for MS. Patients of both sexes should be counselled prior to treatment on infertility and contraceptive use.

Anti-Müllerian hormone and pregnancy after autologous hematopoietic stem cell transplantation for multiple sclerosis

“…Two pregnancies were carried to term. No maternal or neonatal complications were reported in either case [ 12 ]. A retrospective study of the EBMT working party included 324 female patients that were treated with AHSCT for autoimmune diseases, including MS. Twenty-two pregnancies (20 spontaneous) were reported among 15 patients, resulting in live birth in 15/22 pregnancies.…”

“…The Cy/ATG regimen in MS has been increasingly used since the EBMT 2012 guidelines have been published, while the BEAM/ATG has also been maintained [ 2 ]. It has been suggested that the Cy/ATG may impair fertility less in comparison to the BEAM/ATG conditioning regimen [ 12 ]. Massarotti et al did not observe a higher risk of amenorrhea among patients treated with BEAM/ATG conditioning regimen, but this study was not sufficiently powered to detect a difference [ 11 ].…”

Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Patients: Monocentric Case Series and Systematic Review of the Literature

“…In this study, out of 21 males enrolled, one patient has fathered three children since his AHSCT. No newborn complications were reported [70].…”

Autologous haematopoietic stem cell transplantation for immune-mediated neurological diseases: what, how, who and why?

“…While secondary malignancy has been occasionally associated with the use of aHSCT for other indications, in the largest cohort of 507 patients, no cases occurred 19. Healthy babies have been born to both male and female patients following aHSCT, although there are no large cohorts with long-term data 20…”