Ovarian insufficiency following allogeneic hematopoietic stem cell transplantation.
Ovarian insufficiency is a serious complication for young women who undergo hematopoietic stem cell transplantation (HSCT). Reduced-intensity conditioning (RIC) has been utilized more widely due to its reduced toxicity; however, there is a lack of data concerning ovarian function after HSCT with RIC. We investigated the ovarian function in patients who received HSCT with RIC, compared to those who received myeloablative conditioning (MAC). The records of 69 female patients who received allogeneic HSCT at the institution under 40 years of age at transplantation from 1991 to 2012 were retrospectively analyzed. Prevalence of ovarian insufficiency was significantly lower in patients conditioned with RIC than in those conditioned with MAC (4/27 = 14.8% for RIC and 36/42 = 85.7% for MAC, p < 0.0001). A younger age at HSCT was associated with a lower risk of ovarian insufficiency. Among the 40 patients with ovarian insufficiency, four patients recovered ovarian function, and two conceived following hormone-replacement therapy (HRT). A higher serum E2 level prior to HRT was a significant predictor for the restoration of ovarian function (p = 0.0028). In conclusion, RIC was significantly less toxic to ovarian function compared with MAC. HSCT-associated ovarian insufficiency is not irreversible, and a higher E2 level may predict the restoration of ovarian function.
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.|b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan.
Mahiru
M
Kawano
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Hiroko
H
Komura
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Haruna
H
Kawaguchi
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Shoko
S
Shimizu
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Namiko
N
Yada-Hashimoto
c Department of Hematology/Oncology , and.
Mariko
M
Shimizu
c Department of Hematology/Oncology , and.
Maho
M
Sato
c Department of Hematology/Oncology , and.
Masami
M
Inoue
d Department of Gastroenterology and Endocrinology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Shinobu
S
Ida
d Department of Gastroenterology and Endocrinology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Yuri
Y
Etani
d Department of Gastroenterology and Endocrinology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Yasuko
Y
Shoji
d Department of Gastroenterology and Endocrinology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Mariko
M
Nakacho
b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan.
Kenjiro
K
Sawada
b Department of Obstetrics and Gynecology , Osaka University Graduate School of Medicine , Osaka , Japan.
Tadashi
T
Kimura
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Nobuaki
N
Mitsuda
a Department of Pediatric Gynecology , Osaka Medical Center and Research Institute for Maternal and Child Health , Osaka , Japan.
Hirohisa
H
Kurachi
D000328:Adult; D000367:Age Factors; D004958:Estradiol / Q000097:blood*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D017063:Outcome Assessment, Health Care; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011379:Prognosis; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods*; D055815:Young Adult
D004958:Estradiol
Hematopoietic stem cell transplantation; ovarian function; ovarian insufficiency; pregnancy; reduced-intensity conditioning