ESPE Abstracts

Background: With improved treatment and survival of childhood hematological malignancies, the issue of fertility in survivors has become an important domain of holistic care. Haemopoietic stem cell transplant (HSCT) survivors were reported to have reduced fertility as compared to siblings, with 4/170 adult female allogeneic HSCT survivors achieving successful pregnancy.¹ Of 532 female survivors, median age of 17.8 years at HSCT, who had TBI conditioning, 13 pregnancies were reported.² More recent study reported 10/92 female survivors of childhood/adolescent HSCT achieved pregnancy, but 38% had non-malignant diagnoses.³ The data on spontaneous pregnancy in female survivors underwent HSCT under 18 years for malignancies is still lacking.

Aim: To describe the proportion and characteristics of female HSCT survivors who had spontaneous pregnancy with live birth despite a period of documented post-treatment primary or premature ovarian failure, with stratification into TBI and non-TBI groups.

Methods: Retrospective review of all the female survivors of childhood hematological malignancies who had allogeneic HSCT at the Royal Children Hospital between 1985 and 2011. Girls under 18 years and those who described themselves as never sexually active were excluded from analysis.

Results: Seven of forty-four female survivors reported spontaneous pregnancy resulting in live birth. Twenty-five women had received TBI and high dose cyclophosphamide (either as conditioning prior to HSCT or as part of previous chemotherapy), with three reporting pregnancy resulting in live birth. Nineteen of forty-four received busulfan and high dose cyclophosphamide, with four reporting live birth. Median age at HSCT in those who had a pregnancy was 15.5 years for TBI women and 11.5 years for the non-TBI women. Median age at pregnancy was 28.5 years and 26.5 years in TBI and non-TBI groups respectively. Mean time from HSCT to pregnancy was 12 years and 15 years in TBI and non-TBI groups respectively. At conception, 3 women were using oral contraception, 2 were on hormone replacement therapy and 2 were not taking any hormonal supplements when pregnancy was confirmed.

Conclusion: We found a higher proportion of female HSCT survivors having spontaneous pregnancy than reported in previous predominant adult cohorts, and the overall proportion of pregnancy was higher in the non-TBI group. However, findings are limited by small sample size.

References: 1. Carter A et al. Bone Marrow Transplant. 2006 Jun;37(11):1023-9.

2. Sanders JE et al. Blood. 1996 Apr 1;87(7):3045-52.

3. Vatanen A et al. Eur J Endocrinol. 2013 Dec 27;170(2):211-8.