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High rates of ovarian function preservation after hematopoietic cell transplantation with melphalan-based reduced intensity conditioning for pediatric acute leukemia: an analysis from the Japan Association of Childhood Leukemia Study (JACLS)

  • Hisanori FujinoEmail author
  • Hiroyuki Ishida
  • Akihiro Iguchi
  • Masaei Onuma
  • Koji Kato
  • Mariko Shimizu
  • Masahiro Yasui
  • Hiroyuki Fujisaki
  • Kazuko Hamamoto
  • Kana Washio
  • Hirotoshi Sakaguchi
  • Emiko Miyashita
  • Yuko Osugi
  • Etsuko Nakagami-Yamaguchi
  • Akira Hayakawa
  • Atsushi Sato
  • Yoshiyuki Takahashi
  • Keizo Horibe
Original Article
  • 27 Downloads

Abstract

Women are at high risk of hypergonadotropic hypogonadism after hematopoietic cell transplantation (HCT). Hypogonadism is universal after irradiation or busulfan. We hypothesized that reduced intensity conditioning (RIC) might protect ovarian function after HCT. We retrospectively reviewed data from patients with acute leukemia treated according to the Japan Association of Childhood Leukemia Study and nationwide multicenter study protocol. We selected 11 female patients with acute leukemia who received first HCT with RIC, had survived for three or more years after HCT, and were aged ≥ 12 years at the last follow-up visit. Median age at diagnosis, HCT, and last visit were 8, 10, and 17 years. Six patients received HLA-matched bone marrow (BM), two HLA-mismatched BM, and three cord blood. Melphalan was used as conditioning regimen in all patients. At the last visit, six of seven post-pubertal patients at transplantation recovered menstruation, and four of four patients who underwent transplantation at the pre-pubertal began menstruation. Height z scores showed no significant reduction between pre-transplant and post-transplant. No patients received growth hormone treatment. Only one recipient displayed subclinical hypothyroidism. Melphalan-based RIC may be an encouraging option for patients with acute leukemia to avoid ovarian and endocrine dysfunction after HCT.

Keywords

Hypogonadism Hematopoietic cell transplantation Melphalan Reduced intensity conditioning 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Hisanori Fujino
    • 1
    • 2
    Email author
  • Hiroyuki Ishida
    • 2
    • 3
  • Akihiro Iguchi
    • 2
    • 4
  • Masaei Onuma
    • 2
    • 5
  • Koji Kato
    • 2
    • 6
  • Mariko Shimizu
    • 2
    • 7
  • Masahiro Yasui
    • 2
    • 7
  • Hiroyuki Fujisaki
    • 2
    • 8
  • Kazuko Hamamoto
    • 2
    • 9
  • Kana Washio
    • 2
    • 10
  • Hirotoshi Sakaguchi
    • 2
    • 6
  • Emiko Miyashita
    • 2
    • 11
  • Yuko Osugi
    • 2
    • 12
  • Etsuko Nakagami-Yamaguchi
    • 2
    • 13
  • Akira Hayakawa
    • 2
    • 14
  • Atsushi Sato
    • 2
    • 5
  • Yoshiyuki Takahashi
    • 2
    • 15
  • Keizo Horibe
    • 2
    • 16
  1. 1.Department of PediatricsOsaka Red Cross HospitalOsakaJapan
  2. 2.Japan Association of Childhood Leukemia Study Group (JACLS)SuitaJapan
  3. 3.Department of PediatricsKyoto City HospitalKyotoJapan
  4. 4.Department of PediatricsHokkaido UniversitySapporoJapan
  5. 5.Department of Hematology and OncologyMiyagi Children’s HospitalSendaiJapan
  6. 6.Department of Hematology and Oncology, Children’s Medical CenterJapanese Red Cross Nagoya First HospitalNagoyaJapan
  7. 7.Department of Hematology/OncologyOsaka Women’s and Children’s HospitalIzumiJapan
  8. 8.Department of Pediatric Hematology/OncologyOsaka City General HospitalOsakaJapan
  9. 9.Department of PediatricsHiroshima Red Cross Hospital and Atomic-Bomb Survivors HospitalHiroshimaJapan
  10. 10.Department of PediatricsOkayama UniversityOkayamaJapan
  11. 11.Department of PediatricsOsaka UniversitySuitaJapan
  12. 12.Department of PediatricsNational Hospital Organization Osaka Medical CenterOsakaJapan
  13. 13.Department of Medical Quality and Safety ScienceOsaka City UniversityOsakaJapan
  14. 14.Department of PediatricsKobe UniversityKobeJapan
  15. 15.Department of PediatricsNagoya UniversityNagoyaJapan
  16. 16.Department of PediatricsNational Hospital Organization Nagoya Medical CenterNagoyaJapan

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