title: Long-term follow-up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies.
abstract: The purpose of this study was to assess the ovarian function, fertility and bone mineral density in women who previously had treatment for different haematological malignancies (HMs). The overall survival and cure rates of patients with HMs have improved dramatically. The treatment affects fertility and bone density. Fifty-two premenopausal women, from Stockholm region, were included in the study between 1998 and 2002, followed until 2011. The diagnoses were acute lymphoblastic leukaemia (n = 6), acute myeloid leukaemia (n = 10), chronic lymphocytic leukaemia (n = 1), chronic myeloid leukaemia (n = 12), Hodgkin lymphoma (n = 12) and non-Hodgkin lymphoma (n = 11). Before treatment, women without children (43/52), when possible, were offered fertility preservation options. The mean age at diagnosis was 27, at final evaluation 39 yr. Thirty-seven patients received HSCT; 26 allogeneic, 11 autologous. Before allogeneic HSCT, nineteen patients had myeloablative conditioning; seven had reduced-intensity conditioning. Eleven patients got total body irradiation. Eight patients were transplanted with grafts from an HLA-identical sibling donor, while 18 had unrelated donors. All women were in a menopausal state post-therapy. Hormone replacement therapy (HRT) was given, and bone mineral density (BMD) was measured every other year. The serum levels of parathyroid hormone (PTH), free and bound calcium was within normal range. BMD measurements showed a slight increase over time in the spine with a mean of 0.015 g/cm(2) /yr. Four spontaneous pregnancies resulted in two babies and two discontinued pregnancies; two pregnancies were achieved with oocyte donation and surrogacy and one woman adopted a child. HRT sustains BMD in long-term survivors from HMs. This study highlights the importance of HRT and fertility issues in this patient group.
authors.affiliation: Department of Woman and Child Health, Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Sabine
authors.initials: S
authors.lastname: Naessén
authors.forename: Ingrid
authors.initials: I
authors.lastname: Bergström
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Landgren
mesh_terms: D000328:Adult; D015519:Bone Density / Q000187:drug effects / Q000528:radiation effects; D002118:Calcium / Q000097:blood; D005260:Female; D005298:Fertility / Q000502:physiology*; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000534:rehabilitation*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D020249:Hormone Replacement Therapy; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D008137:Longitudinal Studies; D019653:Myeloablative Agonists / Q000627:therapeutic use; D010281:Parathyroid Hormone / Q000097:blood; D017697:Premenopause; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists; D010281:Parathyroid Hormone; D002118:Calcium
keywords: Bone mineral density; fertility preservation; haematological malignancy; haematological stem cell transplantation; hormone replacement theory; premature ovarian failure