Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.
Department of Obstetrics, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.
Eur J Haematol. 2023 Sep;111(3):449-457. doi: 10.1111/ejh.14027. Epub 2023 Jun 12.
Allogeneic hematopoietic stem-cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and its clinical implications among survivors post HCT.
We retrospectively analyzed 30 adult women who had received HCT at premenopausal status between 2015 and 2018. We excluded patients who had received autologous stem cell transplantation, had relapsed, or died of any cause within 2 years of HCT.
The median age at HCT was 41.6 years (range, 22-53). Post-HCT menopause was identified in 90% of myeloablative conditioning (MAC) HCT and 55% of reduced-intensity conditioning (RIC) HCT (p = .101). In the multivariate analysis, the post-HCT menopausal risk was 21 times higher in a MAC regimen containing 4 days of busulfan (p = .016) and 9.3 times higher in RIC regimens containing 2-3 days of busulfan (p = .033) than that of non-busulfan-based conditioning regimens.
Higher busulfan dose in conditioning regimens is the most significant risk factor affecting post-HCT early menopause. Considering our data, we need to decide on conditioning regimens and individualized fertility counseling before HCT for premenopausal women.
异基因造血干细胞移植（HCT）是大多数血液系统恶性肿瘤的唯一根治性选择。然而，HSCT 可导致绝经前女性发生早期绝经和各种并发症。因此，我们旨在研究预测 HCT 后幸存者早期绝经的风险因素及其临床意义。
我们回顾性分析了 2015 年至 2018 年间处于绝经前状态接受 HCT 的 30 名成年女性。我们排除了接受自体干细胞移植、复发或 HCT 后 2 年内因任何原因死亡的患者。
HCT 时的中位年龄为 41.6 岁（范围，22-53）。在 MAC 预处理方案（n=23）和 RIC 预处理方案（n=7）中，分别有 90%和 55%的患者在 HCT 后出现绝经（p=0.101）。多变量分析显示，MAC 方案中含有 4 天的白消安（n=11）与非白消安预处理方案相比，绝经后风险增加 21 倍（p=0.016）；RIC 方案中含有 2-3 天的白消安（n=4）与非白消安预处理方案相比，绝经后风险增加 9.3 倍（p=0.033）。
预处理方案中白消安剂量越高是影响 HCT 后早期绝经的最显著风险因素。考虑到我们的数据，我们需要在 HCT 前为绝经前女性制定预处理方案和个体化生育咨询。
