Treatment of Primary Myelofibrosis in Pregnancy
Primary myelofibrosis presenting in or alongside pregnancy requires immediate reassessment of standard therapy. Several agents used in routine MF management are unsuitable during pregnancy, making early recognition and careful planning essential.
Clinical Context — Pregnancy
Myelofibrosis in pregnancy is associated with an elevated risk of serious obstetric complications. Preconception counselling and a joint specialist approach are central to reducing these risks.
Treatment Approach (partial overview)
Management focuses on identifying and discontinuing agents that pose a teratogenic risk, with transition to appropriate alternatives alongside measures to support a safer pregnancy course.
The full protocol — including which agents to cease, what to switch to, sequencing, and decision criteria — is available via the link below.
References
- MF is associated with higher rates of pregnancy complications including intrauterine growth restriction, placental insufficiency and foetal loss.
- Switching to IFN may be advised where appropriate, in addition to the use of aspirin and low molecular weight heparin (LMWH) to improve pregnancy outcomes.
- Where possible, pregnancy should be managed by a joint obstetric-haematology team with experience of high-risk pregnancies, with preconception counselling and planning for cessation of potentially teratogenic agents such as hydroxycarbamide, warfarin and ruxolitinib.
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