Risk factors of menopause after allogeneic hematopoietic cell transplantation in premenopausal adult women

Objectives Allogeneic hematopoietic stem‐cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and...

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Published in:European journal of haematology 2023-09, Vol.111 (3), p.449-457
Main Authors: Lee, Yoo Jin, Kim, Jeong Sook, Jo, Jae‐Cheol, Kim, Youjin, Im, Hyeon‐Soo, Kim, Hyeyeong, Koh, SuJin, Min, Young Joo, Park, Sang‐Hyuk, Ahn, Jun Woo, Choi, Yunsuk
Format: Article
Language:English
Subjects:
Adult
allogeneic hematopoietic cell transplantation
Allografts
Busulfan
conditioning regimen
early menopause
Female
Graft vs Host Disease - etiology
Hematopoietic Stem Cell Transplantation - adverse effects
Hematopoietic stem cells
Humans
Malignancy
Menopause
Middle Aged
Multivariate analysis
Retrospective Studies
Risk Factors
Stem cell transplantation
Transplantation Conditioning - adverse effects
Transplantation, Autologous
Transplantation, Homologous
Young Adult
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Summary:Objectives Allogeneic hematopoietic stem‐cell transplantation (HCT) is the only curative option for most hematologic malignancies. However, HSCT can cause early menopause and various complications in premenopausal women. Therefore, we aimed to investigate risk factors predicting early menopause and its clinical implications among survivors post HCT. Methods We retrospectively analyzed 30 adult women who had received HCT at premenopausal status between 2015 and 2018. We excluded patients who had received autologous stem cell transplantation, had relapsed, or died of any cause within 2 years of HCT. Results The median age at HCT was 41.6 years (range, 22–53). Post‐HCT menopause was identified in 90% of myeloablative conditioning (MAC) HCT and 55% of reduced‐intensity conditioning (RIC) HCT (p = .101). In the multivariate analysis, the post‐HCT menopausal risk was 21 times higher in a MAC regimen containing 4 days of busulfan (p = .016) and 9.3 times higher in RIC regimens containing 2–3 days of busulfan (p = .033) than that of non‐busulfan‐based conditioning regimens. Conclusions Higher busulfan dose in conditioning regimens is the most significant risk factor affecting post‐HCT early menopause. Considering our data, we need to decide on conditioning regimens and individualized fertility counseling before HCT for premenopausal women.
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.14027