Department of Hematology, Juntendo University School of Medicine, 2-1-1 Hongou, Bunkyoku, Tokyo, 113-8421, Japan.
Department of Hematology, Tokyo Medical University, Tokyo, Japan.
Int J Hematol. 2021 Jan;113(1):106-111. doi: 10.1007/s12185-020-03001-w. Epub 2020 Sep 23.
Essential thrombocythemia (ET) mainly affects the elderly, but can also develop in women of childbearing age. The risk of miscarriage and other complications during pregnancy in ET patients are reported to be higher than that compared to the general population. Therefore, management of pregnancy in ET patients requires special considerations. Several groups recommend interferon (IFN) therapy for ET patients with high-risk pregnancies, but currently no guidelines are available in Japan. We report the outcomes of nine ET patients with ten consecutive high-risk pregnancies. All patients were successfully managed with IFN-α during their pregnancies. All patients also received aspirin and switched to unfractionated heparin around 36 weeks of gestation. As for the seven pregnancies in which IFN-α was started after detection of pregnancy, median platelet counts decreased from 910 to 573 × 10/L after 2 months of IFN-α therapy, and median platelet counts at the time of delivery for all ten pregnancies was 361 × 10/L. All patients gave birth to healthy children. IFN-α was well tolerated, safe, and effective as a cytoreductive therapy for all patients. Although evidence is limited and the use of IFN is not approved in Japan, we suggest considering IFN therapy for high-risk ET pregnancies.
原发性血小板增多症（ET）主要影响老年人，但也可发生在育龄期妇女。据报道，ET 患者在妊娠期间流产和其他并发症的风险高于普通人群。因此，ET 患者的妊娠管理需要特别考虑。一些专家组建议对高危妊娠的 ET 患者进行干扰素（IFN）治疗，但目前日本尚无相关指南。我们报告了 9 例 ET 患者 10 例连续高危妊娠的结局。所有患者在妊娠期间均成功接受 IFN-α 治疗。所有患者在妊娠 36 周左右也接受阿司匹林治疗并转换为未分级肝素。对于在检测到妊娠后开始 IFN-α 治疗的 7 例妊娠，IFN-α 治疗 2 个月后血小板计数中位数从 910×10/L 降至 573×10/L，所有 10 例妊娠的分娩时血小板计数中位数为 361×10/L。所有患者均生下健康的孩子。IFN-α 作为一种细胞减少治疗药物，对所有患者均具有良好的耐受性、安全性和有效性。尽管证据有限，IFN 在日本尚未被批准使用，但我们建议考虑对高危 ET 妊娠使用 IFN 治疗。
