63. Menstrual Suppression in the Myelosuppressed: A Retrospective Chart Review

Abstract

<h3>Background</h3> Adolescents receiving myelosuppressive cancer treatment are at high risk of abnormal uterine bleeding (AUB) in the setting of thrombocytopenia. There are no validated menstrual suppression regimens in this setting, and clinical management is based on studies in healthy women. There has been minimal evaluation of patterns of care in this population. <h3>Methods</h3> We established a retrospective cohort of patients who were aged 15-39y at diagnosis with new or relapsed lymphoma, acute myeloid leukemia, or sarcoma and treated with chemotherapy +/- radiation at a single tertiary pediatric institution between 2008-2019. Our aim was to understand patterns of care by describing patient characteristics and symptoms (packed red blood cell and/or platelet transfusions). The following was abstracted from the medical record: cancer diagnosis, chemotherapy, clinical characteristics, race/ethnicity, payor, menarchal age, menstrual pattern prior to therapy, and cycle control agents utilized. IRB approval was obtained. <h3>Results</h3> Our cohort included 52 patients, the majority of whom were newly diagnosed (73%) and received highly myelosuppressive chemotherapy (85%). The majority of patient records had no documentation of menstrual cycles (81%) or sexual history (89%). A minority of records documented discussion of potential therapy-related infertility (30%) or fertility preservation options (11%); all fertility preservation options discussed were accurate. Eighty-five percent of patients received blood product transfusions. The majority of patients (79%) were prescribed hormonal agents for menstrual suppression; the most utilized agents were depo-medroxyprogesterone (49%) and combined oral contraceptives (39%). The initiation of a menstrual suppression agent varied from prior to (20%), simultaneous with (25%), or after initiating (44%) chemotherapy (Table 1). <h3>Conclusions</h3> Despite AUB being a likely consequence for adolescents receiving myelosuppressive therapies, not all at-risk patients were prescribed menstrual suppression. Agents prescribed and timing of initiation varied widely. The majority of patients received blood products. The majority of patients did not have relevant gynecologic details documented by oncologists. Our study is limited by small sample size and being from a single institution. Ongoing work is evaluating these patterns in a larger cohort, aiming to understand differences in symptomatic AUB and healthcare utilization according to cycle control agents, along with the impact of AUB on adolescent quality of life.