ESPEYB20 7. Oncology and Chronic Disease Gonadal Function and Fertility Issues in Childhood Cancer Survivors (7 abstracts)
7.7. The uterine volume is dramatically decreased after hematopoietic stem cell transplantation during childhood regardless of the conditioning regimen
Courbiere B , Drikes B , Grob A , Hamidou Z , Saultier P , Bertrand Y , Gandemer V , Plantaz D , Plat G , Poirée M , Ducassou S , Pochon C , Dalle JH , Thouvenin S , Paillard C , Kanold J , Sirvent A , Rousset-Jablonski C , Duros S , Gueniffey A , Cohade C , Boukaidi S , Frantz S , Agopiantz M , Poirot C , Genod A , Pirrello O , Gremeau AS , Bringer-Deutsch S , Auquier P & Michel G
blandine.courbiere@univ-amu.fr Fertil Steril. 2023 Apr;119(4):663–672.
Brief summary: This French multicenter prospective study analyzed uterine volume by pelvic MRI in 88 women (age range 18–40 years), who were survivors of childhood acute leukemia treated with hematopoietic stem cell transplantation (HSCT). They were compared to 88 healthy women matched for age and parity.
Conditioning regimens before HSCT included alkylating agents for 34 women and total body irradiation (TBI) for 54 women. Scans were centralized and read double-blinded by two radiologists, unaware of the type of conditioning regimen. 77/88 survivors were considered as having a ‘correct hormonal balance’ on hormone replacement therapy (HRT).
The mean uterine volume was 80 mL in the control group, but 45 mL (−43%) in HSCT women who had received alkylating agents and only 20 mL (−75%) in women who had TBI conditioning. Among women treated with alkylating agents, uterine volume was significantly lower in those with POI not on HRT, compared to women with a correct hormonal balance (15 vs. 49 mL). In contrast, among women treated with TBI, uterine volume was unaffected by adequacy of oestrogenisation (16 vs. 20 mL). Among alkylating agent treated women, those who had reached menarche at the time of HSCT had a significantly lower uterine volume than other women (27 vs. 72 mL).
A total of 18 women (20.4%) reported at least 1 pregnancy, with 8 live births, including 14 women with at least 1 spontaneous pregnancy leading to 6 live births. There were many more live births in among alkylating agent treated women than TBI treated (60% vs. 11%), and live births after spontaneous pregnancy were seen only among women treated with alkylating agents.
Until recently, only radiotherapy was known to damage the uterus and adversely impact on obstetric outcomes after cancer. This interesting study shows that women have decreased uterine volume whatever conditioning was used before HSCT, even if the effects of alkylating agent regimens seem less severe. Strengths of the study are the homogeneous population of HSCT survivors with standardized conditioning regimens, and the blinded MRI analysis. The evaluation of the relationships between age at HSCT, conditioning regimen, and uterine volume and the chance of spontaneous pregnancy and life birth was limited. Finally, different modalities of hormone replacement therapy and patients’ adherence to therapy were not considered potential determinants of uterine volume. It would be interesting to compare this outcome in other conditions that require hormone replacement therapy for puberty induction (e.g., Turner syndrome and congenital hypogonadotropic hypogonadism).
Volume 20
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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