ESPEYB20 7. Oncology and Chronic Disease Gonadal Function and Fertility Issues in Childhood Cancer Survivors (7 abstracts)
7.5. Ovarian function and spontaneous pregnancy after hematopoietic stem cell transplantation for leukemia before puberty: An L.E.A. cohort study
Chabut M , Schneider P , Courbiere B , Saultier P , Bertrand Y , Tabone MD , Pochon C , Ducassou S , Paillard C , Gandemer V , Kanold J , Dalle JH , Poiree M , Plat G , Thouvenin S , Plantaz D , Sirvent N , Weinhard S , Berbis J , Baruchel A , Leverger G , Hamidou Z , Auquier P & Michel G
mathilde.chabut@chu-rouen.fr Transplant Cell Ther. 2023 Jun;29(6):378.e1–378.e9.
Brief summary: This French retrospective observational study evaluated ovarian function, premature ovarian insufficiency (POI) and spontaneous pregnancy in 178 women who had undergone hematopoietic stem cell transplantation (HSCT) for leukemia before puberty; 116/178 had received total body irradiation (TBI) and 62 had received a busulfan-based conditioning regimen.
Sixty percent of women needed pubertal induction; only 40% had spontaneous menarche and half of them later developed POI, most within 5 years after HSCT. Older age at HSCT was associated with a higher risk of POI. Only 22/178 patients (12%) had one or more spontaneous pregnancy, with a total number of 37 spontaneous pregnancies leading to 17 live births, 14 miscarriages, 4 legal abortions and 2 therapeutic abortions.
Interestingly, this study reported that spontaneous puberty and spontaneous pregnancies are possible after HSCT, even if an older age at HSCT is confirmed to be a major risk factor for ovarian dysfunction. Surprisingly, more than 10% of spontaneous pregnancies ended in a legal abortion, suggesting the option to use a replacement therapy with contraceptive effect in young adults to avoid undesired pregnancy. Strengths of the study are the large and homogeneous population, who all received HSCT before puberty, and the long follow up to 18 years post-HSCT. A possible limitation is that they probably underestimated the total number of planned pregnancies, because mean age at the last evaluation, 24.9 years, is still much earlier than the mean age that healthy women have their first child, now around 29 years in European countries.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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