Sexuality- and Fertility-Related Issues in Women after Allogeneic Hematopoietic Stem Cell Transplantation

Nathalie, Forgeard; Jestin, Matthieu; Vexiau, D.; Chevillon, Florian; Ricadat, Élise; Latour, Régis Peffault de; Robin, Marie; Fontbrune, Flore Sicre de; Xhaard, Aliénor; Michonneau, David; Boissel, Nicolas; Poirot, Catherine; Dhédin, Nathalie

doi:10.1016/j.jtct.2021.02.003

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…Although data on types of medications were not available, previous studies suggested that survivors benefit from fertility-enhancing interventions. 17 Comparison with biologic siblings suggested that although survivors were less likely to report live birth compared to their biological siblings, they were also less likely to report spontaneous abortion. These findings suggest that although the prevalence of live birth is significantly diminished after BMT, if pregnancy occurs, the outcome is likely to be favorable.…”

Section: Discussionmentioning

confidence: 99%

Conditioning intensity and probability of live birth after blood or marrow transplantation, a BMTSS report

Balas

Hageman

et al. 2022

Blood Advances

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We examine the impact of conditioning intensity (low intensity: non-myeloablative/reduced intensity vs. high intensity: myeloablative) and total body irradiation (TBI) on the probability of live birth after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS), and included 1,607 survivors transplanted 1974-2014 at age ≤45, with survival ≥2y post-BMT and age at study ≥18. Closest-age, same-sex biologic siblings (n=172) were 1:1 matched with 172 survivors. Survivors and siblings self-reported information on sociodemographic, chronic health conditions, and pregnancies. Within survivor analysis: The association between the primary exposure variable (No TBI/low-intensity conditioning; 200-800cGy TBI/low-intensity conditioning; No TBI/ high-intensity conditioning; >800cGy TBI/ high-intensity conditioning) and the odds of no post-BMT live birth was examined using multivariable logistic regression, adjusting for clinical and demographic variables. Median age at BMT was 31y (IQR=0-45), and median length of follow-up was 14.3y (IQR=2.4-41.4); 39.3% were autologous BMT recipients and 46.6% were female. Overall, 120 (8.7%) survivors reported post-BMT live births. Receipt of >800cGy TBI/ high-intensity conditioning (OR=3.7, 95%CI=1.9-7.0; ref: no TBI/low-intensity conditioning) was associated with higher odds of reporting no live birth post-BMT. In contrast, 200-800cGy TBI/low-intensity conditioning (OR=1.3, 95%CI=0.5-3.3), and no TBI/high-intensity conditioning (OR=0.9, 95%CI=0.5-1.7) were at similar risk of reporting post-BMT live birth as no TBI/low-intensity conditioning. Comparison with biologic siblings: Using conditional logistic regression, we found that BMT survivors were more likely to report no live birth (OR=2.0, 95%CI: 1.2-3.3) compared with siblings. These findings could inform conditioning intensity options for patients wishing to preserve fertility post-BMT.

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Section: Discussionmentioning

confidence: 99%

Conditioning intensity and probability of live birth after blood or marrow transplantation, a BMTSS report

Balas

Hageman

et al. 2022

Blood Advances

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“…Disease and treatments in the context of allo-HCT also have a great impact on ovarian function and family planning initiatives. In a recent study, 63 adult female patients who underwent allo-HCT before the age of 35 years were followed for more than 2 years [ 22 ]. Symptoms of hypoestrogenism were reported by 86% of the patients and changes in sexual life were reported by 76%, mostly because of low sex drive, the negative impact of infertility problems, physical sequelae and loss of self-confidence.…”

Section: Endocrine Dysfunction Post-allo-hctmentioning

confidence: 99%

Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

Alsuliman

Jondreville

Baylet

et al. 2022

JCM

Self Cite

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A person’s sexual and emotional life is greatly impacted after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This topic is not addressed very much by patients and caregivers. Physical, endocrine and genital chronic graft versus host disease (cGVHD)-related disorders are multiple and intertwined with psychological disorders. The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has issued recommendations for a better gynecological monitoring of female recipients after allo-HCT. A patient booklet was also offered to patients in the form of questions and answers to facilitate discussions between patients and caregivers and to improve the management of sexual and emotional life after transplant.

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“…Aside from follicle impact, irradiation also damages the uterus, with reduced distension of the cavity and thinning of the endometrium. Those alterations are associated with increased abortion rate, premature deliveries, and low for gestational age fetuses [52,53].…”

Section: Irradiationmentioning

confidence: 99%

“…The impact of chemotherapy and irradiation is reflected in the whole genital system. Impair of the vascular system, the architecture, temporary atrophy, especially related to irradiation, additionally impact the number of pregnancies and the outcome, significantly lowering the resulting full-term live births [53]. If poor quality or no oocytes are available, patients could undergo egg donation 'In vitro' fertilization (IVF).…”

Section: Fertility Preservation After Cancer Treatmentmentioning

confidence: 99%

A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment

et al. 2021

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Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.

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Sexuality- and Fertility-Related Issues in Women after Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 19 publications

References 25 publications

Conditioning intensity and probability of live birth after blood or marrow transplantation, a BMTSS report

Conditioning intensity and probability of live birth after blood or marrow transplantation, a BMTSS report

Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment

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