Reproductive issues in patients undergoing Hematopoietic Stem Cell Transplantation: an update.
In 1963 George Mathé announced to the world that he had cured a patient of leukaemia by means of a bone-marrow transplant. Since than much progress has been made and nowadays Hematopoietic Stem Cell Transplantation (HSCT) is considered the most effective treatment of numerous severe haematological diseases. Gynaecological complications in HSCT women represent a serious concern for these patients, but often underestimated by clinicians in the view of Overall Survival. The main gynaecological complications of HSCT are represented by: premature ovarian failure (POF), thrombocytopenia-associated menorrhagia, genital symptoms or sexual problems in course of chronic GVHD (cGVHD), osteoporosis, secondary solid tumours due to immunosuppressive drugs to treat cGVHD and severity of cGVHD, and fertility and pregnancy issues. In particular fertility-related issues are always more relevant for patients, whose life expectation is constantly growing up after HSCT.Thus, taking care of a patient undergoing HSCT should primarily include gynaecological evaluation, even before conditioning regimen or chemotherapy for the underlying malignancy, as, in our opinion, it is of great importance to ensure a complete diagnostic work-up and intervention options to guarantee maximum reproductive health and a better quality of life in HSCT women.The present review aims at describing principal features of the aforementioned gynaecological complications of HSCT, and to define, on the basis of current international literature, a specific protocol for the prevention, diagnosis, management and follow-up of gynaecological complications of both autologous and heterologous transplantation, before and after the procedure.
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Maurizio
M
Guida
Ph. D. Program in Translational Medicine, Department of Experimental Medicine, Second University of Naples, Naples, Italy. mantocastaldi@msn.com.|Department of Maternal and Child Health, Operative Unit of Obstetrics and Gynaecology, A.O.R.N. S.G. Moscati, Contrada Amoretta, 83100, Avellino, Italy. mantocastaldi@msn.com.
Maria Antonietta
http://orcid.org/0000-0001-9004-1022
MA
Castaldi
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Rosa
R
Rosamilio
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Valentina
V
Giudice
Department of Sports Science and Wellness, "Parthenope" University of Naples, 80133, Naples, Italy.
Francesco
F
Orio
Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
Carmine
C
Selleri
D019468:Disease Management; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D005298:Fertility; D059247:Fertility Preservation; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010024:Osteoporosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D011247:Pregnancy
D007166:Immunosuppressive Agents