Brady Paula C, Soiffer Robert J, Ginsburg Elizabeth S
Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A.
Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, U.S.A.
Anticancer Res. 2017 Apr;37(4):1985-1987. doi: 10.21873/anticanres.11541.
During treatment of hematologic malignancies in premenopausal women, both menstrual suppression and contraception are crucial. Continuation of hormonal intrauterine devices (IUDs) - widely used and highly effective contraceptives that also decrease menstrual flow - is controversial during hematopoietic stem cell transplants (SCTs) due to infectious and vaginal bleeding concerns.
A 23-year-old nulligravid female was diagnosed with acute myeloid leukemia (AML, positive for FLT3-ITD, DNMT3A and RUNX1, with normal cytogenetics). She elected to retain her existing levonorgestrel-containing IUD during chemotherapy and SCT. During and following treatment, she remained amenorrheic without infection, despite severe neutropenia and thrombocytopenia. Eight months later, she remains in remission without IUD-related complications.
This is the first report of levonorgestrel IUD retention during hematopoietic SCT. Despite severe neutropenia and thrombocytopenia, the patient developed neither pelvic infection by retaining her IUD nor significant vaginal bleeding. Future studies are needed to confirm the safety of levonorgestrel IUDs in women undergoing SCT.
在绝经前女性血液系统恶性肿瘤的治疗过程中，月经抑制和避孕都至关重要。激素宫内节育器（IUD）是广泛使用且高效的避孕方法，同时还能减少月经量，但在造血干细胞移植（SCT）期间，由于存在感染和阴道出血问题，其继续使用存在争议。
一名23岁未孕女性被诊断为急性髓系白血病（AML，FLT3-ITD、DNMT3A和RUNX1阳性，细胞遗传学正常）。她选择在化疗和SCT期间保留现有的含左炔诺孕酮宫内节育器。在治疗期间及之后，尽管出现严重的中性粒细胞减少和血小板减少，她仍处于闭经状态且未发生感染。八个月后，她仍处于缓解期，未出现与宫内节育器相关的并发症。
这是关于造血干细胞移植期间保留左炔诺孕酮宫内节育器的首例报告。尽管存在严重的中性粒细胞减少和血小板减少，但患者保留宫内节育器既未发生盆腔感染，也未出现明显的阴道出血。需要进一步的研究来证实左炔诺孕酮宫内节育器在接受干细胞移植女性中的安全性。
