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ESH CML/MPN 2025 | The clinical challenges associated with pregnancy in patients with MPNs
Martin Griesshammer, MD, Johannes Wesling Medical Center, Minden, Germany, outlines the clinical challenges associated with pregnancy in patients with myeloproliferative neoplasms (MPNs), including a higher rate of spontaneous abortion and late pregnancy loss, which must be discussed with patients who are considering getting pregnant. Pregnant patients are also at a higher risk of thrombosis and hemorrhage. These complications require careful management with antiplatelet drugs, heparins, and potentially cytoreductive drugs, the latter of which can be challenging due to the lack of licensing and data on the safety of these agents in pregnancy. This interview took place at the European School of Haematology (ESH) 4th How to Diagnose and Treat: CML/MPN meeting in Vienna, Austria.
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Transcript
Yeah, there are really some challenges. The first is that pregnant MPN patients have a higher rate of [spontaneous] abortion. This has to be discussed with women when they want to become pregnant. The abortion rate is normally, in a normal pregnancy, whatever that is, is around 10 to 12 percent, and in MPN, it’s increased to 20, 25%.
Normally, it’s early spontaneous abortion...
Yeah, there are really some challenges. The first is that pregnant MPN patients have a higher rate of [spontaneous] abortion. This has to be discussed with women when they want to become pregnant. The abortion rate is normally, in a normal pregnancy, whatever that is, is around 10 to 12 percent, and in MPN, it’s increased to 20, 25%.
Normally, it’s early spontaneous abortion. So spontaneous abortion in the first trimester. But there’s also late pregnancy loss, which is, of course, more severe. But this is a rare event. But this rate also is increased in MPN. So the normal rate is very, very low of late pregnancy losses, and in MPN, it’s around 4%, which is quite a high rate.
The other problems are thrombosis and hemorrhage. So normally you have an increased rate of thrombosis and hemorrhage in MPN, the cause of MPN, and this is of course increased during pregnancy, especially around delivery. So pregnancy has to be managed with antiplatelet drugs, with heparins, and sometimes with cytoreductive drugs. And this is an especially important issue because, you know, it’s very difficult to answer if a cytoreductive drug, and you can only use interferon, is it really safe? We think it is, but there is a discussion around that because there’s no license for interferon.
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