Long-Term Ovarian Function Assessment After Haematopoietic Stem Cell Transplantation in Female Sickle Cell Anaemia Survivors

Olusola Olowoselu; Kehinde S Okunade; Olufemi A Oyedeji; Nosimot O Davies; Obiefuna I Ajie; Ademola Adewoyin; Gaurav Kharya

doi:10.7759/cureus.58195

Long-Term Ovarian Function Assessment After Haematopoietic Stem Cell Transplantation in Female Sickle Cell Anaemia Survivors

Cureus. 2024 Apr 13;16(4):e58195. doi: 10.7759/cureus.58195. eCollection 2024 Apr.

Authors

Olusola Olowoselu¹, Kehinde S Okunade^{2

3}, Olufemi A Oyedeji¹, Nosimot O Davies¹, Obiefuna I Ajie⁴, Ademola Adewoyin¹, Gaurav Kharya⁵

Affiliations

¹ Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, NGA.
² Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, NGA.
³ Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, NGA.
⁴ Chemical Pathology, College of Medicine, University of Lagos, Lagos, NGA.
⁵ Haematology, Oncology, and Bone Marrow Transplant (BMT) Unit, Apollo Hospitals, New Delhi, IND.

Abstract

Background: Haematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for sickle cell anaemia (SCA). While HSCT offers the possibility of disease remission, it can also lead to long-term complications, including gonadal dysfunction and premature menopause.

Methods: We conducted a retrospective cohort study of female survivors who had hydroxyurea therapy and those who underwent post-HSCT follow-up for SCA at a teaching hospital in Lagos, Nigeria, between January 2019 and December 2022. Participants were eligible if they were at least five years post-HSCT or hydroxyurea treatment and had available serum samples for markers of ovarian function measurement. Demographic and clinical data were collected from the hospital register and patients' medical records. Serum levels of oestradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and anti-Müllerian hormone (AMH) were measured using the Abbott Architect i1000SR chemiluminescent immunoassay analyzer (Abbott Diagnostics, Abbott Park, IL). Descriptive statistics and inferential analyses were used to assess the relationship between markers of ovarian function (FSH and AMH) and clinical parameters.

Results: There were statistically significant differences in the median serum levels of all the assessed endocrine hormones between the HSCT and non-HSCT (hydroxyurea) groups of SCA survivors. Up to 82.6% of the SCA survivors experienced ovarian dysfunction after HSCT treatment. Impaired ovarian function in SCA survivors was associated with a longer median follow-up duration than in SCA survivors who had normal ovarian function (12.0 vs. 7.5 years, p = 0.048). There were higher odds of impaired ovarian function in the SCA survivors who had myeloablative regimens than in those who had reduced intensity conditioning regimens (94.1% vs. 50.0%, p = 0.040).

Conclusion: Our study highlights the significant impact of HSCT on long-term ovarian function in female SCA survivors. However, further prospective studies with larger sample sizes and longer follow-up periods are required to confirm our findings and elucidate the factors influencing ovarian function in SCA survivors of HSCT. In addition, studies are also needed to further elucidate the optimal transplant protocols and fertility preservation strategies to minimize gonadal toxicity and preserve reproductive potential in female SCA patients undergoing HSCT.

Keywords: anti-müllerian hormone; bone marrow transplantation; fertility preservation; follicle-stimulating hormone; sickle cell disease.