Outcomes and Challenges of Reproductive Health in Hematopoietic Stem Cell Transplantation Survivors

• Published in: Biology of blood and marrow transplantation 2020-11, Vol.26 (11), p.2127-2131
• Main Authors: Bourlon, Christianne, Riviello-Goya, Santiago, Acosta-Medina, Aldo A, Caballero-Landinez, Rosa E., Manrique-Rubio, Angelica, Teran-De-la-Sancha, Kevin, Gulias-Herrero, Alfonso, Bourlon, Maria T.
• Format: Article
• Language: English
• Subjects: Adult; Female; Fertility; Fertility preservation; Gonadal failure; Hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Low- and middle-income countries; Male; Middle Aged; Quality of Life; Reproductive Health; Retrospective Studies; Survivors
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2020.07.007

•Quality of life in hematopoietic stem cell transplantation (HSCT) survivors is impaired by reproductive outcomes.•Fertility assessment and preservation must be prioritized at time of diagnosis.•In both pre- and post-HSCT settings, women are at higher risk of developing gonadal dysfunction.•Low- and middle-income countries face additional reproductive challenges.•Strategies favoring fertility assessment and preservation are of utmost importance. Long-term therapy-related reproductive health side effects impact the quality of life of hematopoietic stem cell transplantation (HSCT) survivors. In this study, we evaluated the prevalence of gonadal dysfunction (GD) pre- and post-HSCT, analyzed factors associated with GD, and explored rates of fertility assessment (FA) and fertility preservation (FP) in a resource-limited setting. FA and outcomes of patients age ≤45 years undergoing HSCT between June 2000 and May 2018 were collected retrospectively. We included 213 patients with a median age of 26 years. Pre-HSCT FA was performed in 71.8%, with a GD rate of 17%. The rate of GD was not different between the sexes (females, 19.5% versus males, 16.1%; P = .616) and was only associated with increasing age. The rate of cryopreservation in the cohort was 3.3%. Almost one-half (47.7%) of post-HSCT patients completed FA and evidenced an increase in GD rate to 48.9%. Comparing pre-HSCT and post-HSCT GD rates, women had a significant increase (19.5% versus 81.4%; P < .001), whereas men did not (16.1% versus 20.4%; P = .76). These results were confirmed by a multiple imputation analysis accounting for missing data. Female sex, pre-HSCT cytotoxic therapy, myeloablative conditioning, and germ cell tumor (GCT) diagnosis were associated with post-HSCT GD. Reproductive health preservation can be positively impacted when FA and FP are prioritized at the initial diagnosis in HSCT candidates, particularly in women of older age and men with a diagnosis of GCT. The low FP success observed urges implementation of strategies that favor accessibility and improve quality of life of HSCT survivors in low- and middle-income countries.