Human Reproduction, Vol. 18, No. 7, 1410-1416,
July 2003
© 2003 European Society of Human Reproduction and Embryology
Gonadal status in reproductive age women after haematopoietic stem cell transplantation for haematological malignancies
1 Department of Molecular and Clinical Endocrinology and Oncology, 2 Division of Haematology, 3 Department of Gynaecology and Obstetrics, ‘Federico II’ University of Naples, via S.Pansini 5, 80131 Naples and 4 Chair of Obstetrics and Gynecology, University of Cantazaro, Magna Graecia, Italy
5 To whom correspondence should be addressed at: Department of Molecular and Clinical Endocrinology & Oncology, ‘Federico II’ University of Naples, Italy. e-mail: colao{at}unina.it
BACKGROUND: Ovarian failure is a frequent complication occurring after haematopoietic stem cell transplantion (SCT), which is generally ascribed to radiation treatment and antiblastic alkylating agents. METHODS: Ovarian morphology and function were studied in reproductive age women 12–24 months after allogeneic SCT (n = 23) received from an HLA identical sibling, or autologous SCT (n = 22). Thirteen allo-transplanted women were suffering from chronic graft-versus-host disease (cGVHD). RESULTS: Menstrual cycles recovered in two and four women in the allo- and auto-SCT groups respectively, being associated with younger age and longer period elapsed from transplant. There was no difference in previous use of alkylating agents between allo- and auto-transplantation, while corticosteroid treatment was longer and more recent in the allo-SCT group. Significantly higher gonadotrophin levels and lower estradiol were seen in the combined group of patients than in controls. In allo-transplanted women, androgens were also significantly lower than in controls. Ovarian and uterine volumes were lower in patients than in controls, and in the allo- than in the auto-transplanted women. Within the allo-SCT group, endocrine function and ovarian and uterine volumes were significantly lower in the patients suffering from cGVHD. CONCLUSIONS: Ovarian failure in SCT recipients is likely to be caused principally by myelo-ablative treatments, but the condition of gonadal and androgen insufficiency can be worsened by an altered immunomodulation in allogeneic setting.
Key words: busulphan/cyclophosphamide/graft-versus-host disease/ovarian failure/stem cell transplantation
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