Fertility assessment in long-term young female survivors with hematological disease after allogeneic hematopoietic cell transplantation: a single-center real-life cross-sectional study.

Abstract

HSCT has been recognized as a successful treatment for various hematological disease. The 5-year survival rate for children and adolescents diagnosed with hematological disease has risen to over 90% in high-income countries. Nevertheless, it has been reported that between 65 and 84% of individuals who undergo HSCT suffer from premature ovarian failure(POF), with only 0.6% managing to conceive successfully. To report the 5-year experience and evaluate the fertility of young female survivors in HSCT at Peking University People's Hospital, a total of 102 pediatric and female patients aged 8-35 years who underwent HSCT were included. The incidence of POF was 88.2%, 93.9% and 61.5% for young female AML, ALL and AA patients, respectively. The AA group (p = 0.028) had a significantly lower incidence of POF. In the POF group, 89% of patients underwent haploidentical related donor HSCT (p = 0.364) and the cyclophosphamide equivalent dose (CED) of these patients was 10,391 mg/m2 (4890, 10589) (p = 0.222). According to the univariate analysis, an age at HSCT ≥ 13 years (p = 0.007), a diagnosis of AA (p = 0.028), and menarche before and amenorrhea after HSCT (p = 0.016) were associated with POF occurrence. The patients diagnosed with AA had a lower incidence of POF(p = 0.028), while other factors were associated with a higher risk of POF. Multivariate analysis was performed that only age at HSCT was independently associated with POF post-HSCT.