Chiodi Sandra, Spinelli Simonetta, Bruzzi Paolo, Anserini Paola, Di Grazia Carmen, Bacigalupo Andrea
a Hematology Department , IRCCS San Martino-IST , Genoa, Italy.
b Clinical Epidemiology, IRCCS San Martino-IST , Genoa, Italy , and.
J Obstet Gynaecol. 2016 Aug;36(6):783-788. doi: 10.3109/01443615.2016.1154508. Epub 2016 May 6.
Two-hundred and sixty-nine females aged ≤42 and undergoing an allogeneic stem cell transplant were retrospectively studied to assess the effect of age, conditioning regimen and chronic graft-versus-host disease (cGVHD) on resumption of stable menstrual cyclicity. Overall, a stable menstrual cyclicity was observed in 22% of cases. The cumulative probability of menses resumption was significantly age and conditioning regimen related. A statistically significant inverse correlation between cGVHD severity and menses resumption was observed only in univariate analysis. In patients with residual ovarian function, infertility was found in 43% and early menopause in 45%. An increased incidence of prematurity and low birth weight (LBW) was observed among the single spontaneous pregnancies. Follicle-stimulating hormone (FSH) and 17 beta-oestradiol levels were found to be inadequate to detect both early signs of menses resumption and menstrual stability. Our study confirms the crucial role of full dose total body irradiation (TBI) and age on menses recovery and fertility after haematopoietic stem cell transplantation (HSCT). The impact of severe cGVHD remains unclear.
对269名年龄≤42岁且正在接受异基因干细胞移植的女性进行回顾性研究，以评估年龄、预处理方案和慢性移植物抗宿主病（cGVHD）对恢复稳定月经周期的影响。总体而言，22%的病例观察到稳定的月经周期。月经恢复的累积概率与年龄和预处理方案显著相关。仅在单因素分析中观察到cGVHD严重程度与月经恢复之间存在统计学显著的负相关。在有残余卵巢功能的患者中，43%发现不孕，45%出现早期绝经。在单次自然妊娠中观察到早产和低出生体重（LBW）的发生率增加。发现促卵泡生成素（FSH）和17β-雌二醇水平不足以检测月经恢复的早期迹象和月经稳定性。我们的研究证实了全剂量全身照射（TBI）和年龄对造血干细胞移植（HSCT）后月经恢复和生育能力的关键作用。严重cGVHD的影响仍不清楚。
