title: Long-term follow-up of fertility and pregnancy in autoimmune diseases after autologous haematopoietic stem cell transplantation.
abstract: Issues of fertility and pregnancy require special attention in the long-term care of patients with autoimmune diseases (AD), who are candidates for haematopoietic stem cell transplantation (HSCT). In this single-centre observational study, we report fertility status and pregnancy outcomes in 15 patients (11 female and 4 male) after immunoablation with cyclophosphamide, antithymocyte globulin and autologous CD34+-selected HSCT for severe, refractory AD. The median follow-up after HSCT was 12 years (range 2-16 years). Impaired fertility was observed in six patients (five females and one male) before HSCT based on sexual hormone measurements. Higher age and cumulative cyclophosphamide dosage before HSCT correlated with fertility impairment. Median serum level of follicle-stimulating hormone (FSH) was significantly higher in female patients at 1 year after HSCT compared to baseline values, but premature ovarian failure developed in only one patient. Four women had five pregnancies and six healthy offsprings during follow-up, and no miscarriages were observed. The mothers were in treatment-free remissions during conception. No peripartal flare of their AD occurred. Although AD patients undergoing HSCT are at risk of developing infertility, pre-HSCT treatment and patients' age seem to have higher impact on long-term fertility status than HSCT itself. HSCT offers the opportunity to conceive during treatment-free remissions with favourable pregnancy outcomes.
authors: Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany. gero.massenkeil@klinikum-guetersloh.de.|Department of Internal Medicine, Klinikum Guetersloh, Reckenberger Strasse 19, 33332, Guetersloh, Germany. gero.massenkeil@klinikum-guetersloh.de.
authors: G
authors: G
authors: Massenkeil
authors: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors: T
authors: T
authors: Alexander
authors: Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany.
authors: O
authors: O
authors: Rosen
authors: Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany.
authors: B
authors: B
authors: Dörken
authors: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors: G
authors: G
authors: Burmester
authors: German Rheumatism Research Centre, Berlin, Germany.
authors: A
authors: A
authors: Radbruch
authors: Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany.
authors: F
authors: F
authors: Hiepe
authors: Department of Haematology and Oncology, Charité University Medicine, Berlin, Germany.
authors: R
authors: R
authors: Arnold
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000150:complications / Q000628:therapy*; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005298:Fertility / Q000502:physiology*; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007246:Infertility / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000209:etiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D005640:Follicle Stimulating Hormone
keywords: Autoimmune disease; Autologous haematopoietic stem cell transplantation; Fertility; Lupus erythematosus; Pregnancy; Systemic sclerosis