Prevention of Menstruation with Leuprorelin (GnRH Agonist) in Women Undergoing Myelosuppressive Chemotherapy or Radiochemotherapy for Hematological Malignancies: a Pilot Study

• Published in: Leukemia & lymphoma 2001, Vol.42 (5), p.1033-1041
• Main Authors: Lhommé, C., Brault, PH, Bourhis, J. H., Pautier, P., Dohollou, N., Dietrich, P. Y., Akbar-Zadeh, G., Lucas, C., Pico, J. L., Hayat, M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antineoplastic Agents, Hormonal - administration & dosage; Antineoplastic Agents, Hormonal - pharmacology; Antineoplastic Agents, Hormonal - standards; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Female; Fertility Agents, Female - administration & dosage; Fertility Agents, Female - pharmacology; Fertility Agents, Female - standards; gonadotropin-releasing hormone agonist; Hematologic Neoplasms - complications; Hematologic Neoplasms - drug therapy; Hematologic Neoplasms - radiotherapy; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Leuprolide - administration & dosage; Leuprolide - pharmacology; Leuprolide - standards; Megestrol; Menorrhagia - drug therapy; Menorrhagia - prevention & control; menstruation; Menstruation - drug effects; Middle Aged; Norpregnadienes - administration & dosage; Pilot Projects; progestins; thrombocytopenia
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428190109097723

Vaginal bleeding during aplasia can induce transfusion support, infection and discomfort. Oral and intramuscular hormonotherapy can be toxic and/or difficult to manage (mucositis). This single-center pilot study evaluated the efficacy and safety of leuprorelin (L) in preventing heavy vaginal bleeding in 20 nonmenopausal women with leukemia, lymphoma or myeloma and foreseable therapy-induced thrombocytopenia. Until platelet recovery, patients received subcutaneous injections of L, with concomitant nomegestrol acetate (NA) during the first 35 days to prevent flare-up. Median age was 33 years (18-48). Platelet nadir was < 20 × 109/1 in 17 patients; 103 L injections were performed (median per patient: 4 [1-14]). No moderate or severe adverse event was related to hormonal therapy. Seventeen patients did not experience any clinically or therapeutically relevant bleeding. Eleven spottings and 8 metrorrhagias (mean duration: 3 days) occurred in 11 patients, requiring enhanced NA in 3 cases (baseline platelet count was < 20 × 109/1 in 1 pt, premature termination of NA [the single platelet transfusion for metrorrhagia] in 1 pt, and endometrial hyperplasia (EH) in the third). In patients without EH, only 5 spottings were observed after the third injection, without neither clinical nor therapeutic impact (63 injections). In conclusion, leuprorelin administration is safe and effective in preventing vaginal bleeding. The sustained-release form and subcutaneous administration offer quality of life advantages.