Piccioni Paola, Scirpa Paolo, D'Emilio Ilenia, Sora Federica, Scarciglia Marilisa, Laurenti Luca, De Matteis Silvia, Sica Simona, Leone Giuseppe, Chiusolo Patrizia
Instituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy.
Maturitas. 2004 Dec 10;49(4):327-33. doi: 10.1016/j.maturitas.2004.02.015.
To evaluate HRT compliance and efficacy in the treatment of symptomatic ovarian failure in pre-menopausal women after stem cell transplantation (SCT) for malignancies.
Thirty-one females were selected and prospectively followed in a university bone marrow transplantation unit and gynecologic outpatient clinic in a university teaching hospital. The patients received regular gynecological examinations, hormonal assessment every 6 months including plasma levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), 17-beta estradiol (E2), and transvaginal pelvic ultrasonography, mammography, and computerized bone mineralometry every 12 months. Self-assessment form of menopausal symptoms perception was filled in by all patients before HRT and during the observation period.
All patients developed gonadal failure after SCT. The menopausal symptoms more frequently reported were: vasomotor (90%), muscleskeletal symptoms (61%), vulvo-vaginal atrophy (54%), and mood changes (54%). Fifteen premenopausal women out of 31 (51.6%) received systemic HRT on the basis of age (<45 years), absence of medical contraindication or subjective refusal, and complete remission of underlying malignancies post-SCT. The remaining patients (48.4%) did not receive HRT mainly for patient's refusal (29%), relapse of malignancy (13%) or liver toxicity (9.6%). HRT was effective in HRT treated patients promptly relieving unpleasant symptoms of gonadal failure. HRT was tolerated without minimal complications or serious side effects.
Dramatic improvement in menopausal symptoms was observed in women on HRT although treatment was feasible only in nearly half of the patients. HRT alleviates unnecessary discomfort and improves the well-being of female patients post-transplant also by preventing menopause related complications. Feasibility and patients' compliance of HRT should be carefully evaluated in long-term survivors after stem cell transplantation.
评估激素替代疗法（HRT）在恶性肿瘤干细胞移植（SCT）后绝经前女性症状性卵巢功能衰竭治疗中的依从性和疗效。
选取31名女性，在一所大学教学医院的骨髓移植科和妇科门诊进行前瞻性随访。患者接受定期妇科检查，每6个月进行激素评估，包括黄体生成素（LH）、卵泡刺激素（FSH）、17-β雌二醇（E2）的血浆水平，每12个月进行经阴道盆腔超声检查、乳房X线摄影和计算机化骨密度测定。所有患者在HRT前及观察期内填写绝经症状感知自评表。
所有患者在SCT后均出现性腺功能衰竭。最常报告的绝经症状为：血管舒缩症状（90%）、肌肉骨骼症状（61%）、外阴阴道萎缩（54%）和情绪变化（54%）。31名绝经前女性中有15名（51.6%）根据年龄（<45岁）、无医学禁忌证或主观拒绝以及SCT后潜在恶性肿瘤完全缓解的情况接受了全身HRT。其余患者（48.4%）未接受HRT，主要原因是患者拒绝（29%）、恶性肿瘤复发（13%）或肝毒性（9.6%）。HRT对接受治疗的患者有效，能迅速缓解性腺功能衰竭的不适症状。HRT耐受性良好，几乎没有并发症或严重副作用。
接受HRT的女性绝经症状有显著改善，尽管仅近半数患者可行该治疗。HRT还可通过预防绝经相关并发症减轻不必要的不适，改善移植后女性患者的健康状况。干细胞移植后的长期存活者应仔细评估HRT的可行性和患者依从性。
