Function of the hypothalamic–pituitary–gonadal axis in long-term survivors of hematopoietic stem cell transplantation for hematological diseases

Abstract

Gonadal dysfunction in adult long-term survivors of hematopoietic stem cell transplantation (HSCT) is an adverse effect of conditioning regimens consisting of chemotherapy and total body irradiation (TBI). The impact of conditioning regimens consisting of chemotherapy alone on the function of the hypothalamic-pituitary-gonadal (HPG) axis was evaluated in a series of 41 female and 31 male patients who had undergone either autologous or allogeneic bone marrow/peripheral blood stem cell transplantation; mean age at transplantation was 32.6 years and mean time interval from transplantation was 1.5 years (range 0.2-9.8 years). Provocative testing of the HPG axis by administration of luteinizing hormone-releasing hormone was included in the first endocrinological evaluation. The follow-up period extended to three consecutive years. Gonadal dysfunction was not reported by any of the patients prior to their underlying illness. Hypergonadotrophic hypogonadism was observed in 97% of female and 19% of male patients. Leydig cell strain (normal testosterone, high luteinizing hormone levels) was evident in 32% and spermatogenesis damage (high follicle-stimulating hormone levels) in 68% of the male population. At the conclusion of the study four women (10%) had regained spontaneous menses and all hypogonadal men had resumed normal testosterone levels. Our results indicate a high incidence of gonadal dysfunction due to target organ failure in HSCT recipients not treated by TBI.

Physical, psychological, and social sequelae following hematopoietic stem cell transplantation: a review of the literature

“…dryness, narrowing, fibrosis), and dyspareunia [46,65]. Radiation and chemotherapy may result in damage to the gonads and hypothalamic–pituitary–gonad axis that disrupts the sexual response cycle [66]. Fatigue and decreased physical stamina also may contribute to sexual dysfunction [65].…”

Female Long-Term Survivors After Allogeneic Hematopoietic Stem Cell Transplantation: Evaluation and Management

“…Affected women tend to have exaggerated menopausal symptoms including hot flashes, sleep disturbances, vaginal dryness, dyspareunia, mood disturbances and musculoskeletal pain 66 . The most common complaints are decreased desire and lack of lubrication 60,61,67 , resulting in dyspareunia and increased time to orgasm 61 .…”

Ovarian function after hematopoietic cell transplantation: a descriptive study following the use of GnRH agonists for myeloablative conditioning and observation only for reduced-intensity conditioning

“…1 This rate increases to nearly 100% following myeloablative (MA) HCT. 2, 3 Less is known about the incidence of ovarian dysfunction after reduced intensity conditioning (RIC) and the studies addressing this are small and based on retrospective data and isolated patient reports. 4, 5 As well, comparing the ovarian function of prepubertal to pubertal females who are treated for malignancy shows that prepubertal patients are more likely to retain or recover normal ovarian function following conventional (non-HCT, anti-neoplastic) cytotoxic therapy.…”