Challenges and pitfalls in prenatal screening in pregnancies involving allogeneic stem cell transplantation recipients

Prepregnancy Genetic Carrier Screening in Recipients of Hematopoietic Stem Cell Transplants

BACKGROUND

Genetic carrier screening of individuals with a history of hematopoietic stem cell (HSC) transplant is not always straightforward.

CASE

We present the case of a couple who underwent prepregnancy genetic screening before fertility treatment. The genetics laboratory flagged the male partner's blood sample because there was a discrepancy between the sex of the patient and the sex chromosome markers, ultimately leading to the discovery of a prior HSC transplant.

CONCLUSION

A history of HSC transplant may confound results of serum-based genetic carrier screening. Hematopoietic stem cell transplant recipients are at risk for misinterpreted genetic carrier screening because the results of such screening may not actually be reflective of their own DNA.

Female long-term survivors after allogeneic hematopoietic stem cell transplantation: evaluation and management

Female long-term survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) incur a significant burden of late effects. Genital graft-versus-host disease (GVHD), human papillomavirus (HPV) reactivation, ovarian failure and infertility, sexual dysfunction, and osteoporosis are concerns that can significantly impact quality of life. This review examines the risk, pathogenesis, clinical presentation, and implications of these common complications. Recommendations are provided for evaluation and management of these late effects and other obstetric and gynecologic issues that may arise in this patient population.

Gynecologic care in hematopoietic stem cell transplant patients: a review

Over 4500 hematopoietic stem cell transplants (HSCT) are performed on patients in the United States each year. As HSCT patients shift their survivorship care from large transplant centers to community health care providers, many gynecologists are assuming their pre- and post-HSCT gynecologic care. This article reviews recommendations, current research, and expert opinions on the gynecologic care of HSCT patients.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completing this educational activity, the physician should be better able to implement strategies for the prevention and management of menstrual bleeding during hematopoietic stem cell transplants; educate female patients regarding Fertility Preservation options before hematopoietic stem cell transplantation; and apply posthematopoietic stem cell transplant reproductive care screening and treatment recommendations for bone health, sexual health, and secondary cancer development.