January 27 2009 post (see for comments). This is not an easy topic…but okay, here goes…(ah, no, I am not pregnant).
A blog reader recently sent me a message via my blog contact form (by the way, I get a huge amount of correspondence every day, so please forgive me if I don’t answer every single message. I do my best, but…). She is 37 years old and contemplating pregnancy…thing is, she was diagnosed a year ago with SMM. She has been stable since then, has no CRAB symptoms, but is concerned that the myeloma might take off during or after pregnancy.
Good question. Soon after Stefano and I started living together, I bought a whole slew of pregnancy books. Well, we never tried to conceive…for a variety of reasons. Then, in 1999, the year we got married, I was diagnosed with MGUS. I was 38 years old. Even though at the time I didn’t really understand (or, more likely, probably denied) the possible implications of MGUS, I must have had a gut feeling about it (perhaps he did, too), since we simply stopped talking about babies. And a few years ago I gave away all my pregnancy books. No regrets…not anymore, at any rate.
Well, I didn’t really have any useful advice for my blog reader, so I told her that, if she wished (she did), I would write a post about pregnancy and myeloma and ask all the women who read my blog: did you get pregnant after a MGUS, SMM or MM diagnosis? If so, could you tell us how things went, etc.? If you don’t want to post a public comment, please contact me via the blog contact form. I will respect everyone’s privacy.
What I found online was not very encouraging. There don’t seem to be many studies on this topic, which is confirmed in a 2008 Letter to the Editor of the “Annals of Hematology” (http://tinyurl.com/cbkahz): reports of MM in pregnancy are rare, with eight cases arising during pregnancy reported in the literature to date. Here we report the case of a young woman who presented with an aggressive form of MM during the third trimester of pregnancy with spinal cord compression. Whether pregnancy-related factors contributed to the aggressive nature of our patient’s disease is unclear. However, they add, Both interleukin-6 and insulin-like growth factor-1 (IGF-1) promote the survival of malignant plasma cells and intriguingly, raised serum levels of these cytokines have been reported in pregnancy.
I found another study, published in 2004 and titled “Multiple Myeloma with a Pathologic Fracture During Pregnancy” (http://tinyurl.com/c29cun). This appears to be the first reported case of myeloma presenting as a pathologic fracture during pregnancy as well as the first reported cancellation of a planned vaginal delivery because of tumor infiltration of the spine and pelvis. Well, the study is clearly written, so there is no need for me to give a summary here. But I would like to point out that Fifteen months post partum, a painful lytic lesion arose in the tibia, potentially heralding the onset of progressive disease. Whether or not this situation was caused by the pregnancy is not known, of course.
The title of a third study (http://tinyurl.com/dy3hpt), published in 2007, is not exactly encouraging: “Renal failure complicating myeloma in pregnancy.” This study states that there have been nine cases reported of myeloma complicating the pregnancy or the post-partum period. Again, as with the previous study, you can go read it on your own. It’s quite straightforward. Sadly, three months after giving birth, this 32-year-old patient didn’t survive a treatment complication: septicaemia.
In the study’s Discussion, the authors tell us that none of the nine reported cases of myeloma diagnosed during pregnancy had a prior diagnosis of MGUS. They suggest that pregnancy may have contributed to the progression from MGUS to MM, since it may increase the availability of growth factors for MM cells. One of them is the infamous IL-6, by the way.
A 2006 “Immunology” Swedish study (http://tinyurl.com/av7tfs) confirms the close link between growth factors and pregnancy. The researchers examined cytokine responses in both allergic and non-allergic women during pregnancy and two years after delivery. They found elevated spontaneous innate cytokine levels (IL-1beta, IL-6) regardless of allergic status. This interesting, rather technical study ends with this statement: Our finding that women have lower total IgE levels 2 years after pregnancy than in the third trimester also shows that the immune system seems to be modulated by pregnancy, and that the effect is long-lasting.
I also found two other studies that may not be useful at all and also are quite dated (some of the language…no comment!), but perhaps still worth mentioning. The first is a 1966 “Blood” full report (http://tinyurl.com/cepza9). The second was published in 1990 and bears the title “Multiple myeloma in pregnancy: a case report” (abstract: http://tinyurl.com/cg7ey6). One positive titbit is that the babies in both studies were born healthy…I wonder if they grew up to be healthy adults. Too bad there was no follow-up.
In conclusion, I really do wish I had some positive information for my blog reader. Unfortunately, though, I do not.
I would really appreciate any comments and personal stories, good or bad, that might help my blog reader make a decision. Thank you!