Thibaud E, Rodriguez-Macias K, Trivin C, Espérou H, Michon J, Brauner R
Pediatric Endocrinology Unit, Université Paris V and Hopital Necker-Enfants Malades, France.
Bone Marrow Transplant. 1998 Feb;21(3):287-90. doi: 10.1038/sj.bmt.1701075.
Ovarian failure is often brought about by the conditioning protocol used for bone marrow transplantation (BMT). We monitored ovarian function in 31 girls conditioned for BMT at 10.3 +/- 0.6 (s.e., 3.2-17.5) years by chemotherapy alone (group 1, n = 8) or chemotherapy plus body irradiation (12 Gy, fractionated in group 2, n = 9, or 10 Gy single total body in group 3, n = 7, and 5 or 6 Gy single thoraco-abdominal in group 4, n = 7, irradiation) at 13.4 +/- 0.4 (11.7-18.6) years. Breast development was normal (n = 11), did not occur (n = 14), or did not progress spontaneously (n = 2) after BMT. The other four girls who menstruated before BMT had permanent amenorrhea. Basal plasma gonadotropin concentrations were measured in 29; follicle-stimulating hormone was increased in them all and luteinizing hormone in 23. At the last clinical evaluation at 16.3 +/- 0.4 (12.1-21.6) years, 23 girls had complete ovarian failure, two had partial ovarian failure, and six had normal ovarian function. Three of these were the youngest group 1 patients and those who had not received busulfan. We conclude that conditioning for BMT given during childhood frequently prevents normal estrogen secretion at puberty. Adequate substitutive treatment may be necessary to induce growth acceleration and sexual development.
卵巢功能衰竭常由骨髓移植（BMT）所采用的预处理方案引起。我们对31名接受BMT预处理的女孩的卵巢功能进行了监测，这些女孩在10.3±0.6（标准误，3.2 - 17.5）岁时仅接受化疗（第1组，n = 8），或在13.4±0.4（11.7 - 18.6）岁时接受化疗加全身照射（第2组，n = 9，12 Gy，分次照射；第3组，n = 7，单次全身照射10 Gy；第4组，n = 7，单次胸腹照射5或6 Gy）。BMT后乳房发育正常（n = 11）、未出现（n = 14）或未自然进展（n = 2）。另外4名在BMT前已月经来潮的女孩出现了永久性闭经。对29名女孩测定了基础血浆促性腺激素浓度；所有女孩的促卵泡生成素均升高，23名女孩的促黄体生成素升高。在16.3±0.4（12.1 - 21.6）岁的最后一次临床评估时，23名女孩出现了完全性卵巢功能衰竭，2名出现了部分性卵巢功能衰竭，6名卵巢功能正常。其中3名是最年轻的第1组患者且未接受白消安治疗。我们得出结论，儿童期进行的BMT预处理常常会妨碍青春期正常的雌激素分泌。可能需要进行充分的替代治疗以促进生长加速和性发育。
