title: Successful pregnancy following very high-dose total body irradiation (1575 cGy) and bone marrow transplantation in a woman with acute myeloid leukemia.
abstract: A 22-year-old woman had a normal full-term delivery 6 years after a successful allogeneic bone marrow transplantation (BMT) for acute myeloid leukemia (AML). Conditioning therapy consisted of cyclophosphamide (120 mg/kg) and total body irradiation (TBI) to a total of 1575 cGy in seven fractions (225 cGy x 7, at a dose rate of 3.5 cGy/min). Graft-versus-host disease prophylaxis was with methotrexate and cyclosporin A. Grade I acute GVHD developed after BMT but there was no chronic GVHD. She became amenorrhoeic after BMT and serial gonadal testing indicated hypergonadotrophic hypogonadism. She became pregnant and delivered a full-term, healthy baby 6 years after BMT. Successful pregnancy after TBI of more than 1200 cGy is extremely rare. This case, to the best of our knowledge, is the second patient who received a higher dose of TBI (1575 cGy) to have a successful pregnancy. This and previous reports indicate that normal pregnancy is possible after BMT with TBI in excess of 1200 cGy.
authors.affiliation: Department of Medicine, Veterans General Hospital-Taipei, and National Yang-Ming University School of Medicine, Taiwan, ROC.
authors.forename: W S
authors.initials: WS
authors.lastname: Wang
authors.forename: C H
authors.initials: CH
authors.lastname: Tzeng
authors.forename: R K
authors.initials: RK
authors.lastname: Hsieh
authors.forename: T J
authors.initials: TJ
authors.lastname: Chiou
authors.forename: J H
authors.initials: JH
authors.lastname: Liu
authors.forename: C C
authors.initials: CC
authors.lastname: Yen
authors.forename: P M
authors.initials: PM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000532:radiotherapy* / Q000628:therapy*; D008297:Male; D010053:Ovary / Q000528:radiation effects; D011247:Pregnancy; D011879:Radiotherapy Dosage; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014916:Whole-Body Irradiation / Q000009:adverse effects
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide