Canterbury DHB

Women and SCT

After bone marrow transplantation ovarian failure is common but not universal and its incidence is related to the type of conditioning regimen and also to the age of the patient.

• TBI
  • The age of the woman and the total dose of radiation received by the ovary are factors that influence the risk of ovarian failure.
  • Women older than 40 years require doses of only 6 Gy to develop permanent ovarian failure, but younger women may recover gonadal function with doses up to 20 Gy.
  • After TBI, all women appear to have primary ovarian failure with elevated LH and FSH levels, low oestradiol levels and amenorrhoea for varying periods of time. Seattle data show that 7 out of 100 women who received fractionated TBI of 12 to 15.75 Gy (i.e., approximately the same doses as we use in our transplant unit) had recovery of ovarian function after three to four years. These 7 women were all younger than 25 years of age when TBI was administered. Although rare, pregnancies are known to occur following TBI-containing marrow transplant regimens.
• Chemical Conditioning
  • The incidence of ovarian failure is dependent on the dose of the cytotoxic agent and the age of the woman at the time of conditioning.
  • Following busulphan/cyclophosphamide conditioning, all patients develop ovarian failure with amenorrhoea, elevated levels of LH and FSH and low levels of oestradiol. By contrast, ovarian function is often preserved following conditioning for SCT in aplastic anaemia (cyclophosphamide 200 mg/kg). In one study, all patients between the ages of 13 and 25 years had return of menstruation along with normal gonadotrophin and oestrogen levels from 3 to 42 months (median 6 months) after SCT for aplastic anaemia. More than 50% of women older than 26 years had evidence of ovarian recovery.
  • Chemotherapy administered to women just before conception or out of the first trimester usually does not jeopardise the birth of the child, although there may be an increased incidence of foetal loss.
• Hormone Replacement Therapy
  • Prompt hormone replacement therapy is essential for these post SCT patients. See Therapy Induced Menopause for full details.

Topic Code: 8763