Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Biol Blood Marrow Transplant. 2020 Nov;26(11):2127-2131. doi: 10.1016/j.bbmt.2020.07.007. Epub 2020 Jul 10.
Long-term therapy-related reproductive health side effects impact the quality of life of hematopoietic stem cell transplantation (HSCT) survivors. In this study, we evaluated the prevalence of gonadal dysfunction (GD) pre- and post-HSCT, analyzed factors associated with GD, and explored rates of fertility assessment (FA) and fertility preservation (FP) in a resource-limited setting. FA and outcomes of patients age ≤45 years undergoing HSCT between June 2000 and May 2018 were collected retrospectively. We included 213 patients with a median age of 26 years. Pre-HSCT FA was performed in 71.8%, with a GD rate of 17%. The rate of GD was not different between the sexes (females, 19.5% versus males, 16.1%; P = .616) and was only associated with increasing age. The rate of cryopreservation in the cohort was 3.3%. Almost one-half (47.7%) of post-HSCT patients completed FA and evidenced an increase in GD rate to 48.9%. Comparing pre-HSCT and post-HSCT GD rates, women had a significant increase (19.5% versus 81.4%; P < .001), whereas men did not (16.1% versus 20.4%; P = .76). These results were confirmed by a multiple imputation analysis accounting for missing data. Female sex, pre-HSCT cytotoxic therapy, myeloablative conditioning, and germ cell tumor (GCT) diagnosis were associated with post-HSCT GD. Reproductive health preservation can be positively impacted when FA and FP are prioritized at the initial diagnosis in HSCT candidates, particularly in women of older age and men with a diagnosis of GCT. The low FP success observed urges implementation of strategies that favor accessibility and improve quality of life of HSCT survivors in low- and middle-income countries.
长期治疗相关的生殖健康副作用会影响造血干细胞移植（HSCT）幸存者的生活质量。在这项研究中，我们评估了 HSCT 前后性腺功能障碍（GD）的发生率，分析了与 GD 相关的因素，并在资源有限的环境中探讨了生育评估（FA）和生育保存（FP）的比例。回顾性收集了 2000 年 6 月至 2018 年 5 月期间接受 HSCT 的年龄≤45 岁的患者的 FA 和结局。共纳入 213 例患者，中位年龄为 26 岁。71.8%的患者在 HSCT 前进行了 FA，GD 发生率为 17%。两性之间 GD 发生率无差异（女性为 19.5%，男性为 16.1%；P=0.616），且仅与年龄增长相关。该队列中冷冻保存率为 3.3%。近一半（47.7%）的 post-HSCT 患者完成了 FA，GD 发生率增加到 48.9%。比较 pre-HSCT 和 post-HSCT 的 GD 发生率，女性显著增加（19.5%比 81.4%；P<0.001），而男性无明显变化（16.1%比 20.4%；P=0.76）。通过对缺失数据进行多重插补分析，得到了同样的结果。女性、HSCT 前细胞毒性治疗、清髓性预处理和生殖细胞肿瘤（GCT）诊断与 post-HSCT GD 相关。在 HSCT 候选者的初始诊断中优先考虑 FA 和 FP，可以积极促进生殖健康保存，特别是对于年龄较大的女性和诊断为 GCT 的男性。观察到 FP 成功率较低，这促使我们在中低收入国家实施有利于 HSCT 幸存者获得途径和提高生活质量的策略。
