Carter A, Robison L L, Francisco L, Smith D, Grant M, Baker K S, Gurney J G, McGlave P B, Weisdorf D J, Forman S J, Bhatia S
Population Sciences, City of Hope Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
Bone Marrow Transplant. 2006 Jun;37(11):1023-9. doi: 10.1038/sj.bmt.1705364.
We conducted a retrospective study to describe the magnitude of compromise in reproductive function and investigate pregnancy outcomes in 619 women and partners of men treated with autologous (n=241) or allogeneic (n=378) hematopoietic cell transplantation (HCT) between 21 and 45 years of age, and surviving 2 or more years. Median age at HCT was 33.3 years and median time since HCT 7.7 years. Mailed questionnaires captured pregnancies and their outcomes (live birth, stillbirth, miscarriage). Thirty-four patients reported 54 pregnancies after HCT (26 males, 40 pregnancies; eight females, 14 pregnancies), of which 46 resulted in live births. Factors associated with reporting no conception included older age at HCT (> or =30 years: odds ratio (OR)=4.8), female sex (OR=3.0), and total body irradiation (OR=3.3). Prevalence of conception and pregnancy outcomes in HCT survivors were compared to those of 301 nearest-age siblings. Although the risk for not reporting a conception was significantly increased among HCT survivors (OR=36), survivors were not significantly more likely than siblings to report miscarriage or stillbirth (OR=0.7). Although prevalence of conception is diminished after HCT, if pregnancy does occur, outcome is likely to be favorable. Patients should be counseled prior to transplant regarding strategies to preserve fertility.
我们进行了一项回顾性研究，以描述619名年龄在21至45岁之间、接受自体（n = 241）或异体（n = 378）造血细胞移植（HCT）且存活2年或更长时间的女性及其男性伴侣的生殖功能受损程度，并调查其妊娠结局。HCT时的中位年龄为33.3岁，HCT后的中位时间为7.7年。通过邮寄问卷收集妊娠情况及其结局（活产、死产、流产）。34名患者报告了HCT后的54次妊娠（26名男性，40次妊娠；8名女性，14次妊娠），其中46次为活产。与未受孕相关的因素包括HCT时年龄较大（≥30岁：比值比（OR）=4.8）、女性性别（OR = 3.0）和全身照射（OR = 3.3）。将HCT幸存者的受孕率和妊娠结局与301名年龄最接近的兄弟姐妹进行了比较。尽管HCT幸存者未报告受孕的风险显著增加（OR = 36），但幸存者报告流产或死产的可能性并不比兄弟姐妹显著更高（OR = 0.7）。尽管HCT后受孕率降低，但如果发生妊娠，结局可能是良好的。应在移植前向患者提供关于保留生育能力策略的咨询。
