Adolescent and adult uterine volume and uterine artery Doppler blood flow among subjects treated with bone marrow transplantation or chemotherapy in pediatric age A case control study

Capsule:
Bone marrow transplantation, total body irradiation, and busulfan use in pediatric patients are associated with subsequent reduction of uterine size and increased vascular resistance.

Authors:
Fausta Beneventi, M.D., Elena Locatelli, M.D., Giovanna Giorgiani, M.D., Marco Zecca, M.D., Tommaso Mina, M.D., Margherita Simonetta, M.D., Chiara Cavagnoli, M.D., Mara Albanese, M.D., Arsenio Spinillo, M.D.

Volume 103, Issue 2, Pages 455-461

Abstract:

Objective:
To compare uterine and ovarian volumes and uterine artery (UA) Doppler blood flow among women who were treated with antineoplastic regimens when pediatric aged versus healthy controls.

Design:
Case-control study.

Setting:
Tertiary obstetric and gynecologic center.

Patient(s):
One hundred twenty-seven women who were treated for childhood cancer with bone marrow transplantation (BMT) and∖or chemotherapy and total body irradiation (TBI) and 64 age-matched healthy controls.

Intervention(s):
Ultrasonographic and clinical evaluations.

Main Outcome Measure(s):
Uterine and ovarian volume, detection of follicles, and UA pulsatility index (PI).

Result(s):
Median uterus and ovarian volumes were reduced by 64% (95% CI, 56.6–70.6) and 83.6% (95% CI, 79.6–86.7), respectively, among cases compared with controls. Median UA PI among cases was increased by 30.3% (95% CI, 19.6–40.8) compared with controls. Ovarian follicles were identified in 24 (18.9%) of 127 cases and 25 (39%) of 64 controls. Uterine volume was reduced after TBI (percent reduction 81.9%; 95% CI, 71.8–87.8) or busulfan (percentage reduction 67.4%; 95% CI, 58.5–75.6) compared with those who had not received a conditioning regimen (percentage reduction 24.4%; 95% CI, 7.6–38.2). The only factors independently associated with reduced uterine and ovarian volumes compared with controls were TBI, busulfan, and BMT. The worst effect on UA PI resulted from BMT and a diagnosis of hematologic disease.

Conclusion(s):
Bone marrow transplantation as main treatment and TBI and busulfan as conditioning regimens had the worst effect on uterine and ovarian sizes compared with controls. These data should be considered in counseling families on preserving future fertility in children undergoing BMT.

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