Gonadotropin Releasing Hormone agonist may minimize premature ovarian failure in young women undergoing autologous stem cell transplantation

Capsule:
Gonadotropin-releasing hormone agonist cotreatment in conjunction with conditioning chemotherapy before stem cell transplantation may significantly decrease gonadotoxicity and premature ovarian failure in lymphoma but not in leukemia patients.

Authors:
Zeev Blumenfeld, M.D., Biren Patel, M.D., Ronit Leiba, M.Sc., Tsila Zuckerman, M.D.

Volume 98, Issue 5, Pages 1266-1270.e1, November 2012

Abstract:

Objective:
To compare the rate of premature ovarian failure (POF) after stem cell transplantation (SCT) in young women receiving GnRH-agonist (GnRH-a) in conjunction with gonadotoxic chemotherapy.

Design:
Prospective, nonrandomized study.

Setting:
Tertiary university hospital.

Patients:
Ninety-five women received conditioning chemotherapy, with or without GnRH-a before SCT. Complete information was available only for 83 patients.

Interventions:
Conditioning chemotherapy, with or without GnRH-a before SCT.

Main Outcome Measures:
Cyclic ovarian function (COF), or premature ovarian failure (POF) after SCT.

Results:
There were no significant differences in age, chemotherapy treatment, or diagnoses between the study and control groups. In the GnRH-a group 38.3% (18/47) patients resumed COF compared to 11.1% (4/36) for patients who did not receive GnRH-a. Patients who resumed COF were an average 3.7 years (median 3 years) younger at the time of transplantation than those who experienced POF. GnRH-a had a significant effect on long term COF in patients with lymphomas [66.7% (14/21) for GnRH-a group vs. 18.2% (2/11) for control,] but not for leukemia patients.

Conclusion:
GnRH-a cotreatment in parallel to conditioning chemotherapy before SCT may significantly decrease the gonadotoxicity and POF from 82% to 33% in lymphoma but not in leukemia patients.

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