Female Gonadal Function Following Reduced Intensity Conditioning (RIC) Allogeneic Bone Marrow Transplantation for Haematological Malignancies.

It is generally accepted that recipients of myeloablative allogeneic bone marrow transplants will have markedly reduced gonadal function post transplantation and are likely to be rendered infertile. Many of these patients will also have received intensive pre-transplant chemotherapy leading to significant gonadotoxicity even before transplantation. During the last decade, conditioning regimes of reduced intensity have been developed in an effort to reduce the short and long term toxicities associated with myeloablative transplants,. We studied pre and post-transplant gonadal function of 27 female patients undergoing RIC using Fludarabine, Melphalan and CAMPATH-1H regimen. GVHD prophylaxis consisted of cyclosporine (CyA) except one patient with AML who received CyA/MTX rather than CAMPATH-1H. The median age at transplantation was 33 years (19–45). Fourteen patients had Hodgkin lymphoma, 6 Non Hodgkin lymphoma, 4 multiple myeloma 2 MDS and one AML. Of these patients, 22 were shown to have reduced gonadal function prior to transplantation, as a result of previous intensive chemotherapy (11 patients had previous autologous transplant). The remaining five patients were shown to have preserved gonadal function pre-transplantation as evidenced by LH, FSH, oestradiol and prolactin levels within the normal range. One patient with myeloma had received VAD chemotherapy prior to transplant, one patient with lymphoma CHOP-R × 6, one with AML standard induction anthracycline based chemotherapy while 2 patients with MDS were allografted with no preceding chemotherapy. Post transplantation, all five patients were shown to have preserved gonadal function at a median follow up of 22 months (8–35). This was evidenced by clinical (regular menstruation), biochemical (normal hormonal profile), and radiological (ovarian ultrasonography) parameters. One patient become pregnant naturally twice and gave birth to two healthy children. In contrast to patients receiving fully myeloablative conditioning regimes, female patients with normal gonadal function who receive reduced intensity conditioned allografts can retain gonadal function and fertility. These results have implications in fertility counselling and should be taken into consideration in decision making, especially in young women for whom preservation of fertility is of paramount importance.