Clinical and biologic evaluation of ovarian function in women treated by bone marrow transplantation for various indications during childhood or adolescence

Abstract

Objective: To evaluate which factors determine premature ovarian failure after bone marrow transplantation (BMT) during childhood and adolescence.

Design: Cross-sectional study.

Setting: Academic teaching hospital.

Patient(s): Thirty-five women with previous allogeneic (n = 19) or autologous (n = 16) BMT for benign (n = 12) or malignant disease (n = 23). Mean age at BMT was 9.8 ± 5.2 years. Eighteen patients had received total body irradiation (TBI). Twenty-three (66%) were premenarchal at the time of BMT.

Intervention(s): Evaluation of ovarian function.

Main outcome measure(s): Retrospective analysis of gynecologic history and hormone measurements (FSH, E(2), and antimüllerian hormone [AMH]) in relation to initial pathology, treatment protocols, age, and menarchal status at the time of BMT and time elapsed since BMT.

Result(s): Clinical evidence of persistent ovarian function after BMT was found in 46% of patients (16/35), but low AMH concentrations (<1.2 μg/L) were observed in 85% of patients, including a large subset (2/3) of clinically eugonadal subjects. Age ≤10 years at the time of BMT and absence of TBI were significantly and independently associated with higher rates of clinically proven persistent ovarian function at the time of evaluation.

Conclusion(s): After BMT, ovarian function is impaired in the majority of women, even without clinical signs of premature ovarian failure. This impairment is mostly related to older age at the time of treatment and conditioning treatment with TBI.