Ovarian Function and Spontaneous Pregnancy After Hematopoietic Stem Cell Transplantation for Leukemia Before Puberty: An LEA Cohort Study

被引:8
作者
Chabut, Mathilde [1 ,22 ]
Schneider, Pascale [2 ]
Courbiere, Blandine [3 ]
Saultier, Paul [4 ,5 ]
Bertrand, Yves [6 ]
Tabone, Marie -Dominique [7 ]
Pochon, Cecile [8 ]
Ducassou, Stephane [9 ]
Paillard, Catherine [10 ]
Gandemer, Virginie [11 ]
Kanold, Justyna [12 ]
Dalle, Jean-Hugues [13 ,14 ]
Poiree, Maryline [15 ]
Plat, Genevieve [16 ]
Thouvenin, Sandrine [17 ]
Plantaz, Dominique [18 ]
Sirvent, Nicolas [19 ]
Weinhard, Sara [8 ]
Berbis, Julie [20 ,21 ]
Baruchel, Andre [14 ]
Leverger, Guy [7 ]
Hamidou, Zeinab [20 ,21 ]
Auaquier, Pascal [20 ,21 ]
Michel, Gerard [4 ,20 ,21 ]
机构
[1] Univ Hosp Rouen, Dept Pediat, 37 Blvd Gambetta, F-76000 Rouen, France
[2] Univ Hosp Rouen, Dept Pediat Hematol & Oncol, Rouen, France
[3] Avignon Univ, Hop La Conception, AP HM,IMBE,CNRS,IRD, Aix Marseille Univ,Dept Gynecol Obstet & Reprod M, Marseille, France
[4] La Timone Childrens Hosp, APHM, Dept Pediat Hematol Immunol & Oncol, Marseille, France
[5] Aix Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
[6] Univ Hosp Lyon, Dept Pediat Hematol & Oncol, Lyon, France
[7] Sorbonne Univ, Armand Trousseau Hosp, AP HP, Dept Pediat Hematol & Oncol, Paris, France
[8] Childrens Hosp Brabois, Dept Pediat Hematol & Oncol, Brabois, France
[9] Univ Hosp Bordeaux, Dept Pediat Hematol & Oncol, Bordeaux, France
[10] Univ Hosp, Dept Pediat Hematol Oncol, Strasbourg, France
[11] Univ Hosp Rennes, Dept Pediat Hematol & Oncol, Rennes, France
[12] Univ Hosp Clermont Ferrand, Dept Pediat Hematol & Oncol, Clermont Ferrand, France
[13] Univ Hosp St Louis, Dept Pediat Oncohematol, Paris, France
[14] Nord Univ Paris Cite, Hop Robert Debre, GHU APHP, Dept Hematol & immunol, Paris, France
[15] Univ Hosp LArchet, Dept Pediat Hematol & Oncol, Nice, France
[16] Univ Hosp Toulouse, Dept Pediat Hematol & Oncol, Toulouse, France
[17] CHU St Etienne, Dept Pediat Oncohematol, St Etienne, France
[18] Univ Hosp Grenoble, Dept Pediat Hematol & Oncol, Grenoble, France
[19] Univ Hosp Montpellier, Dept Pediat Hematol & Oncol, Montpellier, France
[20] Hop La Timone, CEReS Res Unit EA 3279, Marseille, France
[21] Hop La Timone, Dept Publ Hlth, Marseille, France
[22] Univ Hosp Rouen, Dept Pediat, 37 Blvd Gambetta, F-76000 Rouen, France
来源
TRANSPLANTATION AND CELLULAR THERAPY | 2023年 / 29卷 / 06期
关键词
Leukemia; Premature ovarian insufficiency; Hematopoietic stem cell trans-plantation; QUALITY-OF-LIFE; BONE-MARROW-TRANSPLANTATION; LONG-TERM; REPRODUCTIVE-PERFORMANCE; FERTILITY PRESERVATION; CHILDHOOD LEUKEMIA; TISSUE; SURVIVORS; ADOLESCENT; OUTCOMES;
D O I
10.1016/j.jtct.2023.02.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Ovarian function impairment and infertility are among the most frequent late effects after hematopoietic stem cell transplantation (HSCT). The aim of this study was to evaluate ovarian function, occurrence of premature ovarian insufficiency (POI), and spontaneous pregnancy in a large cohort of adult survivor women who had undergone HSCT for leukemia before puberty. We conducted a retrospective observational study in women from the national cohort L.E.A., the long-term French follow-up program after childhood leukemia. The median follow-up duration was 18 years (14.2-23.3) after HSCT. Among 178 women, 106 (60%) needed pubertal induction with hormone substitution treatment, whereas 72 (40%) had spontaneous menarche. After spontaneous menarche, 33 (46%) developed POI, mostly within 5 years of HSCT. Older age at time of HSCT and cryopreservation of ovarian tissue appeared as significant risk factors for POI. More than 65% of patients who underwent HSCT before the age of 4.8 years had spontaneous menarche, and almost 50% didn't have POI at last evaluation, whereas more than 85% with HSCT after the age of 10.9 years didn't have spontaneous menarche and needed induction of puberty with hormone replacement therapy. Twenty-two women (12%) had at least one spontaneous pregnancy, with 17 live-births, 14 miscarriages, 4 legal abortions, and 2 therapeutic abortions. These results add supplementary data to better counsel patients and their families on the chances of ovarian residual function and pregnancy after HSCT, as well as on the potential interest of fertility preservation.
引用
收藏
页码:378.e1 / 378.e9
页数:9
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