Objective: To investigate the levels of sex hormone and fertility in female patients after hematopoietic stem cell transplantation (HSCT), as well as their correlation with conditioning regimens, and analyse the effect of hormone replacement therapy (HRT) in young women after HSCT. Methods: Retrospective case series study. The clinical data of 147 women who underwent HSCT in the First Affiliated Hospital of Soochow University from January 2010 to January 2021 were retrospectively analyzed. The sex hormone levels were measured and followed-up, and the survival, menstrual fertility and the use of HRT of the patients were also followed-up. The sex hormone levels were measured after transplantation, and the ovarian function was evaluated. Independent sample t test and χ2 test were used for comparison between the two groups. Results: The median age of the 147 patients was 26 (range, 10-45) years. Of them, 135 patients received allogeneic HSCT and 12 patients received autologous HSCT. Furthermore, 129 patients received myeloablative conditioning, and 18 patients received reduced conditioning dose. The median follow-up time was 50 months (range, 18-134 months). Five patients died of disease recurrence during follow-up. Of the 54 patients with subcutaneous injection of zoladex, three recovered menstruation spontaneously after transplantation, and all of them were myeloablative conditioning patients, one patient gave birth to twins through assisted reproductive technology. Ninety-three patients did not use zoladex before conditioning, two patients with aplastic anemia with non-myeloablative transplantation resumed menstruation spontaneously, and conceived naturally. The level of follicle stimulating hormone after transplantation in patients receiving myeloablative conditioning regimen was significantly higher than that in patients receiving reduced-dose conditioning regimen [(95.28±3.94) U/L vs. (71.85±10.72) U/L, P=0.039]. Among 147 patients, 122 patients developed premature ovarian failure, 83 patients received sex hormone replacement therapy after transplantation, and 76 patients recovered menstruation and improved endocrine function. Conclusions: The incidence of premature ovarian failure is high in female patients after HSCT, and patients have a chance at natural conception. Reducing the dose of conditioning regimen and the application of zoladex before transplantation can reduce ovarian of conditioning drugs. HRT after transplantation can partially improve the endocrine function of patients.
目的： 初步探索造血干细胞移植后女性性激素水平及生育情况，及其与预处理方案的相关性，并分析移植后年轻女性激素替代治疗的效果。 方法： 回顾性病例系列研究。选取2010年1月至2021年1月在苏州大学附属第一医院接受造血干细胞移植后进行性激素水平检测随访的147例女性患者的临床资料，分析随访患者的生存、月经及生育情况，激素替代治疗情况，检测移植后患者性激素水平，评估患者卵巢功能。采用独立样本t检验、χ2检验等进行组间比较。 结果： 147例患者年龄10~45岁，中位年龄26岁，异基因造血干细胞移植135例，自体造血干细胞移植12例；129例接受清髓性预处理，18例接受减低剂量预处理。随访18~134个月，中位数为50个月，5例患者因疾病复发而死亡。54例预处理前使用醋酸戈舍瑞林的患者中3例移植后自行恢复月经，均为清髓性预处理患者；1例通过辅助生殖技术分娩双胎。93例预处理前未使用醋酸戈舍瑞林的患者中2例自行恢复月经，均为再生障碍性贫血非清髓性预处理，并自然受孕。接受清髓性预处理的患者移植后卵泡刺激素水平显著高于接受减低剂量预处理的患者［（95.28±3.94）U/L比（71.85±10.72）U/L，P=0.039］。147例患者中，122例发生卵巢功能早衰，83例患者移植后采用性激素补充治疗，76例恢复月经，改善内分泌功能。 结论： 造血干细胞移植后女性卵巢早衰发生率高，患者有自然受孕可能；减低预处理剂量及移植前应用醋酸戈舍瑞林可减少预处理药物的卵巢毒性。移植后采用激素替代治疗可改善患者的部分内分泌功能。.