Mathilde Chabut, Pascale Schneider, Blandine Courbiere, Paul Saultier, Yves Bertrand, Marie-Dominique Tabone, Cécile Pochon, Stéphane Ducassou, Catherine Paillard, Virginie Gandemer, Justyna Kanold, Jean-Hugues Dalle, Maryline Poiree, Geneviève Plat, Sandrine Thouvenin, Dominique Plantaz, Nicolas Sirvent, Sara Weinhard, Julie Berbis, André Baruchel, Guy Leverger, Zeinab Hamidou, Pascal Auquier, Gérard Michel
Transplant Cell Ther. 2023 Jun;29(6):378.e1-378.e9
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.
Keywords: Hematopoietic stem cell transplantation; Leukemia; Premature ovarian insufficiency