Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: a pilot study.
Vaginal bleeding during aplasia can induce transfusion support, infection and discomfort. Oral and intramuscular hormonotherapy can be toxic and/or difficult to manage (mucositis). This single-center pilot study evaluated the efficacy and safety of leuprorelin (L) in preventing heavy vaginal bleeding in 20 nonmenopausal women with leukemia, lymphoma or myeloma and foreseable therapy-induced thrombocytopenia. Until platelet recovery, patients received subcutaneous injections of L, with concomitant nomegestrol acetate (NA) during the first 35 days to prevent flare-up. Median age was 33 years (18-48). Platelet nadir was < 20 x 10(9)/l in 17 patients; 103 L injections were performed (median per patient: 4 [1-14]). No moderate or severe adverse event was related to hormonal therapy. Seventeen patients did not experience any clinically or therapeutically relevant bleeding. Eleven spottings and 8 metrorrhagias (mean duration: 3 days) occurred in 11 patients, requiring enhanced NA in 3 cases (baseline platelet count was < 20 x 10(9)/l in 1 pt, premature termination of NA [the single platelet transfusion for metrorrhagia] in 1 pt, and endometrial hyperplasia (EH) in the third). In patients without EH, only 5 spottings were observed after the third injection, without neither clinical nor therapeutic impact (63 injections). In conclusion, leuprorelin administration is safe and effective in preventing vaginal bleeding. The sustained-release form and subcutaneous administration offer quality of life advantages.
Lhommé
C
C
Medical Gynecologic Oncology Unit, Institut Gustave-Roussy, Villejuif, France. lhomme@igr.fr
Brault
P
P
Bourhis
J H
JH
Pautier
P
P
Dohollou
N
N
Dietrich
P Y
PY
Akbar-Zadeh
G
G
Lucas
C
C
Pico
J L
JL
Hayat
M
M
D000293:Adolescent; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000494:pharmacology* / Q000592:standards; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000494:pharmacology / Q000592:standards; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016729:Leuprolide / Q000008:administration & dosage / Q000494:pharmacology* / Q000592:standards; D008535:Megestrol; D008595:Menorrhagia / Q000188:drug therapy / Q000517:prevention & control; D008598:Menstruation / Q000187:drug effects*; D008875:Middle Aged; D009649:Norpregnadienes / Q000008:administration & dosage; D010865:Pilot Projects
D018931:Antineoplastic Agents, Hormonal; D005300:Fertility Agents, Female; D007166:Immunosuppressive Agents; D009649:Norpregnadienes; C038501:nomegestrol acetate; D008535:Megestrol; D016729:Leuprolide