Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL.
Department of Population Sciences and Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA; and.
Blood Adv. 2022 Apr 26;6(8):2471-2479. doi: 10.1182/bloodadvances.2021006300.
We examine the impact of conditioning intensity (low intensity: nonmyeloablative/reduced intensity vs high intensity: myeloablative) and total body irradiation (TBI) on the probability of live birth after blood or marrow transplantation (BMT). Study participants were drawn from the BMT Survivor Study (BMTSS) and included 1607 transplant survivors between 1974 and 2014 at age ≤45 years, with survival ≥2 years post-BMT and age at study ≥18 years. Closest-age, same-sex biologic siblings (n = 172) were 1:1 matched with 172 survivors. Survivors and siblings self-reported information on sociodemographic, chronic health conditions, and pregnancies. Within survivor analysis: the association between the primary exposure variable (no TBI/low-intensity conditioning; 200 to 800 cGy TBI/low-intensity conditioning; no TBI/high-intensity conditioning; >800 cGy TBI/high-intensity conditioning) and the odds of no post-BMT live birth were examined using multivariable logistic regression, adjusting for clinical and demographic variables. Median age at BMT was 31 years (IQR, 0 to 45), and median length of follow-up was 14.3 years (IQR, 2.4 to 41.4); 39.3% were autologous BMT recipients, and 46.6% were female. Overall, 120 (8.7%) survivors reported post-BMT live births. Receipt of >800 cGy TBI/high-intensity conditioning (odds ratio [OR], 3.7; 95% CI, 1.9-7.0; ref: no TBI/low-intensity conditioning) was associated with higher odds of reporting no live birth post-BMT. In contrast, 200 to 800 cGy TBI/low-intensity conditioning (OR, 1.3; 95% CI, 0.5-3.3), and no TBI/high-intensity conditioning (OR, 0.9; 95% CI, 0.5-1.7) were at similar risk of reporting post-BMT live birth as no TBI/low-intensity conditioning. Comparison with biologic siblings: Using conditional logistic regression, we found that BMT survivors were more likely to report no live birth (OR, 2.0; 95% CI, 1.2-3.3) compared with siblings. These findings could inform conditioning intensity options for patients wishing to preserve fertility post-BMT.
我们研究了预处理强度（低强度：非清髓性/减强度与高强度：清髓性）和全身照射（TBI）对≤45 岁年龄的血液或骨髓移植（BMT）后活产概率的影响。研究参与者来自 BMT 幸存者研究（BMTSS），包括 1974 年至 2014 年间生存≥2 年的 1607 名 BMT 幸存者，且研究时年龄≥18 岁。年龄最接近的同性别生物同胞（n=172）按 1:1 与 172 名幸存者匹配。幸存者和同胞自我报告社会人口统计学、慢性健康状况和妊娠信息。在幸存者分析中：使用多变量逻辑回归，调整临床和人口统计学变量，研究主要暴露变量（无 TBI/低强度预处理；200 至 800cGyTBI/低强度预处理；无 TBI/高强度预处理；>800cGyTBI/高强度预处理）与无 BMT 后活产的几率之间的关联。BMT 的中位年龄为 31 岁（IQR，0 至 45），中位随访时间为 14.3 年（IQR，2.4 至 41.4）；39.3%为自体 BMT 受者，46.6%为女性。总体而言，120 名（8.7%）幸存者报告了 BMT 后活产。接受>800cGyTBI/高强度预处理（比值比[OR]，3.7；95%CI，1.9-7.0；参考：无 TBI/低强度预处理）与 BMT 后报告无活产的几率较高相关。相比之下，200 至 800cGyTBI/低强度预处理（OR，1.3；95%CI，0.5-3.3）和无 TBI/高强度预处理（OR，0.9；95%CI，0.5-1.7）与无 TBI/低强度预处理的报告 BMT 后活产的风险相似。与生物同胞的比较：使用条件逻辑回归，我们发现与同胞相比，BMT 幸存者更有可能报告无活产（OR，2.0；95%CI，1.2-3.3）。这些发现可以为希望在 BMT 后保留生育能力的患者提供预处理强度选择。
