Mechanism and management of treatment-related gonadal failure in recipients of high dose chemoradiotherapy

Autologous or allogeneic SCT with conventional conditioning (chemotherapy with or without irradiation) has emerged as an effective and potentially curative therapy in patients with hematologic malignancies and in other selected solid tumors; however, several patients experience significant early and delayed side effects, including longterm endocrine imbalance and infertility. In spite of several reproductive recovery and pregnancy reports published in the oncology literature, review of medical literature reveals a paucity of comparable information in the SCT field. We report here four cases of ovarian recovery in patients who received hormonal replacement therapy after diagnosis of primary ovarian failure due to high-dose chemotherapy and SCT.

Section: Discussionmentioning

confidence: 99%

Ovarian recovery after stem cell transplantation

Liu

Malhotra

Voltarelli

et al. 2007

“…In women, FSH and LH levels rise and oestradiol levels fall owing to follicular destruction as a result of chemotherapy and radiotherapy. 17 In the study of Mertens et al, 13 older age at SCT was correlated with an increased risk in the development of elevated gonadotrophin levels. They concluded that women were not only more likely to develop elevated gonadotrophin levels than men, but also did so earlier after SCT.…”

Section: Tablementioning

confidence: 95%

Quality of life, reproduction and sexuality after stem cell transplantation with partially T-cell-depleted grafts and after conditioning with a regimen including total body irradiation

Claessens

Beerendonk

Schattenberg

2006

Thirty-four men and 36 women (median age 43 and 45 years, respectively) underwent stem cell transplantation (SCT) for acute leukaemia in first complete remission or chronic myelogenous leukaemia in first chronic phase between 1981 and 2001 from HLA-identical siblings. The conditioning regimen included TBI and all grafts were partially depleted of T cells. Changes in quality of life (QOL), reproduction and sexuality were studied using a questionnaire, and the previously given information related to these problems was assessed. In addition, endocrine status was assessed and semen analysis was performed. After SCT, patients reported less energy (n ¼ 50) and a deterioration in the job situation (n ¼ 31). Patients experienced a negative change in sexual relations (n ¼ 41). Important problems of sexual dysfunction were vaginal dryness in women (n ¼ 19) and erectile dysfunction in men (n ¼ 16). None of the patients was fertile based on their gonadotrophin levels, sperm concentrations and reproductive outcomes. Women experienced climacteric symptoms (n ¼ 24). Quality of life was negatively influenced by these changes. One-fifth of the patients were not satisfied with the information given with regard to reproduction, premature menopause and sexual problems.

“…1,32 High-dose chemotherapy, especially alkylating agents and total-body irradiation, are toxic to gonadal function and can contribute to genital tissue sensitivity, atrophy or scarring. 34 Psychosexual functioning, impotence-related difficulties and altered body image were significantly correlated with the type of chemotherapy administered. 27 This may explain why significant differences occurred between patients undergoing allogeneic HSCT and patients receiving maintenance chemotherapy with respect to impotence-related difficulties.…”

Section: Study Findingsmentioning

confidence: 97%

The impact of hematopoietic stem cell transplantation on sexuality: a systematic review of the literature

Thygesen

Schjødt

Jarden

2011

In this paper we review evidence concerning the impact of hematopoietic SCT (HSCT) on sexuality. The aims are to determine: (1) the sexual changes experienced by patients following allogeneic or autologous HSCT, and its consequences; (2) changes in the sexual function over time and (3) the impact of physiological changes induced by intensive treatment with radiation and chemotherapy on sexual functioning. Four databases were searched for articles published between January 1995 and May 2011. A total of 14 studies were identified and analyzed. We found that (1) multiple aspects of sexuality were affected, and the impact and etiology of these sexual alterations were different between genders, and (2) recovery of sexual activity and pleasure occurred in the first 2 years after HSCT, although it appears that some survivors are more likely to experience sexual dysfunction even 5-10 years after HSCT as compared with controls; and (3) there was contradictory evidence concerning possible differences between allogeneic and autologous HSCT, although there was a significant relation between the sexual dysfunctions and the type of chemotherapy administrated as conditioning and chronic GVHD. Future prospective research in sexual dysfunction with specific reliable validated instruments and more adequate sample sizes will be required to definitively evaluate the impact of HSCT on sexuality.