Case Report Suggests Improved Outcomes of PV During Pregnancy With Cytoreductive Treatment, Aspirin

To date, just a small number of cases have documented polycythemia vera (PV) in pregnant women. This rare myeloproliferative neoplasm poses a particular risk of thrombosis in these patients and requires anti-platelet treatment. A group of researchers looked at the case of a pregnant women with PV to add to the limited information of managing the condition in these patients.

Three years after being diagnosed with JAK2-positive marked PV, the 38-year-old patient became pregnant. In addition to receiving her current medication, the patient began anticoagulant treatment while being closely monitored by both her obstetrician and hematologist.

“The particularity of the case of PV in pregnancy presented herein embodies the difficulties in diagnosis of this pathology in a woman of fertile age, and the need for interdisciplinary collaboration in order to obtain a good and safe outcome for both mother and child,” emphasized the researchers, writing in Experimental and Therapeutic Medicine. “A young age for PV, but an advanced maternal age is the most challenging background for a high‐risk pregnancy with multiple and complex associated diseases.”

On the 23­rd week of pregnancy, cytoreductive treatment was reduced to pegylated interferon‐α twice a week, owing to the favorable evolution of PV. While hydroxyurea is typically the preferred drug for initial PV treatment due to its efficacy, limited toxicity, and low cost, young patients and pregnant patients often instead receive interferon‐α because it offers the possibility of a cytogenic remission. The treatment also offers favorable safety in pregnant patients compared to hydroxyurea.

Throughout the pregnancy, ultrasound showed normal fetal growth and normal amniotic fluid index, and the patient experienced no thrombotic events. The baby was born with no neonatal complications.

“To the best of our knowledge, there are limited studies available in the literature debating the management of PV in pregnancy,” wrote the researchers. “A recent study by Robinson et al concluded that it is essential for the optimal fetal prognosis to act actively in the hemogram balance.”

Based on the European Collaboration on Low‐Dose Aspirin in Polycythemia Vera trial, it is suggested that 100 mg of aspirin daily reduces the risk of non‐fatal myocardial infarction, non‐fatal stroke, pulmonary embolism, major venous thrombosis, or death from cardiovascular causes. In the current case study, 150 mg of aspirin was considered based on screening and preventing pre-eclampsia and other fetal and maternal complications. Enoxaparin was added due to peripheral venous insufficiency with a high risk of thrombosis. According to the researchers, the case study suggests that better results are achieved when using cytoreductive treatment and low-dose aspirin.

Reference

Bohiltea R, Niculescu-mizil E, Mihai B, et al. Polycythemia vera in pregnancy represents a challenge for a multidisciplinary collaboration: A case report and literature review. Exp Ther Med. 2022;23(1):19. doi: 10.3892/etm.2021.10941