Hormone Replacement Therapy and Chronic Graft‐versus‐Host Disease Activity in Women Treated with Bone Marrow Transplantation for Hematologic Malignancies

Balleari, Enrico; Garrè, S.; Lint, Maria Teresa Van; Spinelli, S; Chiodi, S; Repetto, Enrico; Massa, G; Bacigalupo, Andrea; Ghio, Riccardo

doi:10.1111/j.1749-6632.2002.tb04214.x

Cited by 21 publications

(11 citation statements)

References 13 publications

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“…The risks and benefits of hormone therapy need to be discussed, along with a plan for when hormone therapy would be discontinued and under what conditions. In a non-randomized study of younger women who did versus did not take hormone therapy, taking hormones did not effect chronic GVHD in allogeneic survivors 19. Nonetheless hormone therapy would not be an option for women with elevated risks for hormone-sensitive tumors or those who have chronic GVHD of the liver.…”

Section: Medical Treatment Optionsmentioning

confidence: 95%

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Sexuality After Hematopoietic Stem Cell Transplantation

Yi¹,

Syrjala²

2009

The Cancer Journal

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As survival rates for hematopoietic stem cell transplantation (HSCT) have grown in the past two decades with improved management of acute toxicities, 1-2 attention to long term complications has become more salient to clinicians, researchers, and survivors themselves. Sexual dysfunction has been defined as one of the most common long term issues following HSCT. 3-4 Prospective studies have described the extent and nature of sexual difficulties in this population, 4-6 and have also documented elevated problem rates relative to healthy controls. 3-4,7-8 The aims of this article are to review the state of knowledge about sexual dysfunction following HSCT, to examine issues related to sexual dysfunction, and to address strategies to treat these long term problems.HSCT is a procedure designed primarily for hematologic malignancies such as leukemia and lymphoma, although some solid tumors and non-malignant diseases such as aplastic anemia are also treated with this aggressive treatment method. Prior to the transplant, to prepare the body to receive stem cells, the conditioning regimens always include chemotherapy, usually supralethal doses of an alkylating agent such as cyclophosphamide or busulfan, and often including total body irradiation (TBI) at a dose of 1200 cGy or higher. This process lowers immune defenses so that stem cells from either marrow or peripheral blood, donated from oneself (autologous) or from another person (allogeneic) can be infused. If the transplant is allogeneic, survivors are at risk for chronic graft versus host disease (GVHD), where the donor immune cells identify the body as foreign and attack it. Chronic GVHD can manifest anywhere in the body and often involves the skin, liver, eyes, mouth, sinuses and gut. 2 For women, vaginal mucosal tissues are particularly susceptible. Chronic GVHD is managed with the use of immunosuppressants that often include high dose corticosteroids along with a calcineurin inhibitor such as cyclosporine or other newer agents that suppress immune recovery and bring a host of potential additional complications.Recent efforts to reduce the toxicities of HSCT have utilized very low dose chemotherapies and TBI in attempts to optimize a 'graft versus leukemia' effect. This increasingly widely used methodology for treating hematologic malignancies seems to spare gonadal function along with other organ systems, but risks for chronic GVHD remain.The population of HSCT survivors who receive high dose treatment is usually well under the age of 50, and most often relatively healthy until their diagnosis. Since treatment is so arduous and potentially toxic, major comorbidities are exclusions for eligibility for transplant. Thus

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Section: Medical Treatment Optionsmentioning

confidence: 95%

“…. Prospective cohort studies indicate that hormone therapy with oral estrogen improves or prevents more serious decline in sexual function in women after HSCT, but does not eliminate problems 5,19,26…”

Section: Risk Factors For Sexual Dysfunction After Hsctmentioning

confidence: 99%

Sexuality After Hematopoietic Stem Cell Transplantation

Yi¹,

Syrjala²

2009

The Cancer Journal

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“…35 Prospective studies indicate that hormone therapy with oral estrogen ameliorates more serious decline in sexual function in women after HCT, but it does not eliminate problems. 3,36 Androgen For personal use only. on May 12, 2018.…”

Section: Discussionmentioning

confidence: 99%

Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years

Syrjala

Kurland

Abrams

et al. 2008

Blood

112

103

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This prospective study evaluated sexual function through 5 years after myeloablative allogeneic hematopoietic cell transplantation (HCT) for cancer to determine sexual function recovery and residual problems. Adults completed measures before HCT (N ‫؍‬ 161), with survivors followed at 6 months and at 1, 2, 3, and 5 years. At 5 years case-matched controls also completed assessments. Analyses indicated that men and women differed in rates of being sexually active across time (P < .001) and in overall sexual function (P < .001). Both sexes declined in sexual activity rates and sexual function from before HCT to 6 months afterward (P < .05). Activity rates recovered for men by 1 year (74%) and for women by 2 years (55%). Men improved from their 6-month nadir in sexual function by 2 years (P ‫؍‬ .02), whereas women did not improve by 5 years (P ‫؍‬ .17). Both male and female survivors were below controls in rates of sexual activity and sexual function at 5 years. Most women reported sexual problems (80% of survivors vs 61% of controls, P ‫؍‬ .11); in contrast for men 46% of survivors versus 21% of controls (P ‫؍‬ .05) reported problems. Thus, despite some recovery, sexual dysfunction remained a major problem for men and women after HCT. Aggressive efforts are needed to treat these deficits.

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“…There is evidence that HRT does not increase the risk of cGVHD exacerbation and prevents some adverse effects of long-lasting ovarian failure in young women. 26,27 Oral bisphosphonates proved to be effective for treating postmenopausal and glucocorticoid-induced osteoporosis. 14,15,17 In a previous study from our group, a 12-month treatment with a daily dose of 5 mg of risedronate increased BMD by 5.9% at the LS and prevented bone loss at the femoral neck in a mixed population of allo-transplanted patients.…”

Section: Discussionmentioning

confidence: 99%