title: Fertility recovery and pregnancy after allogeneic hematopoietic stem cell transplantation in Fanconi anemia patients.
abstract: Reduced fertility is one clinical manifestation among other well known Fanconi anemia features. Most recipients of allogeneic hematopoietic stem cell transplantation suffer from secondary infertility owing to gonadal damage from myeloablative conditioning. In order to evaluate the rate of pregnancy in Fanconi anemia transplanted patients, we performed a retrospective analysis of female patients transplanted in 15 centers from 1976 to 2008. Among 578 transplanted Fanconi anemia patients, we identified 285 transplanted females of whom 101 patients were aged 16 years or over. Ten became pregnant (4 twice). Before hematopoietic stem cell transplantation all had confirmed Fanconi anemia diagnosis. Median age at transplantation was 12 years (range 5-17 years). Conditioning regimen consisted of cyclophosphamide with or without irradiation. During follow up, 5 of 10 patients presented signs of ovarian failure. Among those, 2 patients spontaneously recovered regular menses, and 3 received hormonal replacement therapy. Pregnancy occurred from four to 17 years after hematopoietic stem cell transplantation. Three patients had preterm deliveries, one patient had a hysterectomy for bleeding. All 14 newborns had normal growth and development without congenital diseases. In conclusion, recovery of normal ovarian function and a viable pregnancy is a realistic but relatively rare possibility even in Fanconi anemia patients following hematopoietic stem cell transplantation. Mechanisms of fertility recovery are discussed.
authors.affiliation: Eurocord Hospital Saint Louis, 1 Avenue Claude Vellefaux, Paris, France.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Nabhan
authors.forename: Marco A
authors.initials: MA
authors.lastname: Bitencourt
authors.forename: Michel
authors.initials: M
authors.lastname: Duval
authors.forename: Manuel
authors.initials: M
authors.lastname: Abecasis
authors.forename: Carlo
authors.initials: C
authors.lastname: Dufour
authors.forename: Karim
authors.initials: K
authors.lastname: Boudjedir
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.forename: Kumiko
authors.initials: K
authors.lastname: Goi
authors.forename: Jean
authors.initials: J
authors.lastname: Sanders
authors.forename: John
authors.initials: J
authors.lastname: Snowden
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yabe
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pasquini
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
mesh_terms: D005199:Fanconi Anemia / Q000150:complications* / Q000628:therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007246:Infertility / Q000209:etiology; D008297:Male; D011247:Pregnancy; D020127:Recovery of Function; D012189:Retrospective Studies; D014184:Transplantation, Homologous