Gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation-a single-center real-life cross-sectional study

Huina Su; Xinyu Zhou; Yanli Zhao; Yue Lu; DeYan Liu; Janping Zhang; Xin Yang

doi:10.3389/fmed.2022.956867

Gynecological complications in long-term survivors after allogeneic hematopoietic cell transplantation-a single-center real-life cross-sectional study

Front Med (Lausanne). 2022 Sep 15:9:956867. doi: 10.3389/fmed.2022.956867. eCollection 2022.

Authors

Huina Su¹, Xinyu Zhou², Yanli Zhao³, Yue Lu³, DeYan Liu³, Janping Zhang³, Xin Yang¹

Affiliations

¹ Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
² Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, Beijing, China.
³ Department of Bone Marrow Transplantation, Hebei Yanda Lu Daopei Hospital, Langfang, China.

Abstract

Background and objectives: Hematopoietic stem cell transplantation (HCT) is a treatment for hematopoietic diseases. However, most cured female patients may suffer from premature ovarian insufficiency (POI) after HCT, which is mainly caused by the pre-HCT conditioning regimen. Hence, this study aims to explore the impact of HCT treatment on reproductive and ovarian functions in female survivors.

Methods: A total of 55 female participants under the age of 40, who underwent HCT and met the inclusion criteria were enrolled. Data related to blood disease, menstruation, and fertility in the 3 years following HCT were collected.

Results: The involved patients received transplantation at different age stages, ranging from 8 to 37. All patients, except those with aplastic anemia (AA; 5/55), received a myeloablative conditioning regimen, usually modified total body irradiation/cyclophosphamide (TBI/Cy; 25/55) or modified Busulfan/cyclophosphamide (Bu/Cy; 23/55). Among women (42/55) who menstruated before HCT, 16.67% (7/42) had a spontaneous menstrual relapse and 83.3% (35/42) had amenorrhea after HCT. 72.7% (40/55) could be regarded as having POI. This proportion included 100% (25/25) of women aged 21-40 at the time of HCT, 62.5% (15/24) of those aged 11-20, and 0% (0/6) of those ≤10 years old. Patients with AML were more likely to have POI (95.7%). Patients aged ≤10 years (0%) or 11-20 years (16.7%) at the time of HCT were less likely to have moderate to severe menopause than those 21-40 years old (44%).

Conclusion: The prevalence of POI following HCT was high and POI was associated with age, conditioning regimen, and type of blood disease.

Keywords: conditioning regimen; hematopoietic stem cell transplantation; myeloablative conditioning regimen; obstetrics and gynecology; premature ovarian insufficiency.