Myelodysplastic Syndromes

Siddiqui et al.62 described five women diagnosed with myelodysplastic syndromes (MDS) during pregnancy from 1982 to 1987 (see Table 106.4). Steensma et al.63 identified all patients at the Mayo Clinic with MDS and pregnancy seen between 1976 and 2000. A total of seven pregnancies were discovered, occurring in four patients with MDS between 1983 and 2000. In three of the four patients, MDS was suspected after an initial CBC for routine prenatal care. Patients were between 21 and 42 years of age. After bone marrow evaluation, all patients had refractory anemia except one with refractory anemia with excess blasts (RAEB). Three patients, including the RAEB patient, delivered normal term

Table 106.4 Myelodysplasia associated with pregnancy

Maternal Gestational Subclass; Pregnancy Maternal age (year) week course or therapy outcome outcome

22 16 RAEB; septic endometritis Therapeutic abortion AML by 4th month; expired after 2 years

31 12 RA; no CBC changes Therapeutic abortion Expired 1 month after MRD-BMT

after abortion

32 20 RA; transfusional support Healthy, term infant AML in 5th month, increased platelets postpartum; expired

31 30 RAEB; no treatment Down syndrome infant AML after 2 years; expired at 36 week

31 Unknown Unknown Low birth weight infant Postpartum AML; expired

Reprinted with permission from Siddiqui T. et al.

CR, complete response; MRD-BMT, matched related donor-bone marrow transplant; RA, refractory anemia.

infants. The other patient developed spontaneous abortion. Only one patient required therapy for MDS due to rapid progression into acute leukemia; she was treated with idarubicin and cytarabine at 30 weeks gestation without remission, and treated again with same agents successfully prior to delivery. She delivered a healthy infant and subsequently underwent a matched unrelated allogeneic stem cell transplantation 2 months postpartum and remained in remission.63

Although only a handful of cases of MDS with pregnancy have been reported, the relative indolence of MDS suggests that termination of pregnancy should only be a consideration seldom. In most patients, disease-specific therapy can be postponed until after delivery, but patients in the high-risk International Prognostic Scoring System (IPSS) may require cytotoxic therapy during pregnancy.63

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