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Clinical Lymphoma, Myeloma & Leukemia, Vol. 13, No. 6, 704-10 ª 2013 Elsevier Inc. All rights reserved.
Keywords: Allogeneic stem cell transplantation, Chemotherapy, Fertility preservation, Hormone replacement therapy
Premature ovarian failure
Emmanuelle Assouline et al
20 MM 33 Yes 0 0 140 Yes 2 73 TBI Amenorrhea 0 54 89 14 0.9 0 POF
21 CLL 40 Yes 5087 0 0 Yes 3 60 Flu-Ritux Unknowne 0 18 7 13 0.6 HC POF
22 NHL 35 0 3701 267 0 0 1 5 Flu-Bu-ATG Amenorrhea 0 2.5 0.2 35 0.6 0 POF
Abbreviations: AA ¼ aplastic anemia; ALL ¼ acute lymphoblastic leukemia; Allo-SCT ¼ allogeneic stem cell transplantation; AMH ¼ anti-Müllerian hormone; AML ¼ acute myeloide leukemia; ATG ¼ antithymocyte globulin; Bu ¼ busulfan; CLL ¼ chronic lymphocytic leukemia;
Cy ¼ cyclophosphamide; E2 ¼ estradiol; Flu ¼ fludarabine; FSH ¼ follicle stimulating hormone; HC ¼ hormonal contraception; HL ¼ hodgkin's lymphoma; HRT ¼ hormonal replacement therapy; HT ¼ hormonal therapy; IVF ¼ in vitro fertilization; LH ¼ luteinizing hormone;
MM ¼ multiple myeloma; NHL ¼ non-Hodgkin’s lymphoma; POF ¼ premature ovarian failure; RIC ¼ reduced intensity conditioning; Ritux ¼ rituximab; TBI ¼ total body irradiation; U ¼ unrealized.
a
Patient who underwent preservation fertility with emergency IVF before RIC Allo-SCT (8 embryos cryopreserved).
b
Patient who underwent ovarian cryopreservation before RIC Allo-SCT.
c
Patient who underwent preservation fertility with emergency IVF before RIC Allo-SCT with cancellation of the cycle because of an absence of follicular response to ovarian stimulation.
d
Patient given artificial insemination but did not result in pregnancy.
e
Unknown status: menstrual bleeding using HC.
- 707
Reduced-Intensity Conditioning and Fertility
After myeloablative conditioning regimen, pregnancy rate is
Fertility Rate
geneic transplant for malignant or nonmalignant diseases. In addi-
tion, fertility before Allo-SCT and parenthood desire is unknown.
For this reason, results concerning pregnancy rates have to be
interpreted with caution. Moreover, after myeloablative condition-
ing, the rate of POF is very high, from 95% to 100%.3,4
Successful pregnancies were reported in a total of 6 women with
hematological malignancies after RIC Allo-SCT.13-15 Interestingly,
median interval to pregnancy was short (6 months, and 1 and 2 years)
Recovery of Ovarian Function
Unspecified
Table 4 Main Series Describing Ovarian Function and Fertility After Allogeneic Stem Cell Transplantation with Myeloablative Conditioning
alone or in combination
Chemotherapy protocol
variable alone or in
variable alone or in
malignanacies
hematological
hematological
hematological
malignancies
Pathology
(8865, 6883, and 6331 mg/m2), despite the fact that cyclophos-
phamide is among the most gonadotoxic chemotherapy agents.
Sanders et al6 also reported that postpubertal patients who received
high-dose cyclophosphamide during conditioning were likely to
recover their ovarian function.
Besides the issue of fertility, POF is also associated with estrogen
deprivation that increases the risk of osteoporosis, cardiovascular
disease, and sexual and urinary dysfunction.19 There is neither
Retrospective
Retrospective
Retrospective