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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, M. D., Pochon, C., Ducassou, S., Paillard, C., Gandemer, V., et al
Transplantation and cellular therapy. 2023
Abstract
BACKGROUND Ovarian function impairment and infertility are among the most frequent late effects after hematopoietic stem cell transplantation (HSCT). OBJECTIVE The aim of this study was to evaluate ovarian function, occurence of premature ovarian insufficiency (POI), and spontaneous pregnancy in a large cohort of adult survivor women who had received HSCT for leukemia before puberty. STUDY DESIGN 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. RESULTS 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. CONCLUSION These results add supplementary data to better counsel patients and their families on the chances of ovarian residual function and pregnancy post-HSCT as well as on the potential interest of fertility preservation.