GONADAL FUNCTIONS IN 24 PATIENTS AFTER BONE MARROW TRANSPLANTATION

Abstract

The long term follow-up of patients after bone marrow transplantation (BMT) allows for a more precise definition of its potential side-effects. Gonadal functions are potentially sensitive to several procedures regularly used for BMT preparations, either total body irradiation (TBI) or high dose regimen chemotherapy. We present a series of 24 patients aged at least 14 years previously treated by BMT, either before or after onset of puberty. There were 17 boys and 7 girls. Mean age at BMT was 13,2 for the boys and 11,2 tor the girls. 11 did not show any sign of pubertal development at the time of BMT. The indications for BMT were ALL in 11, ANLL in 2, lymphoma in 4, Chronic leukemia in 1, aplastic anaemia in 4 and solid tumors in 1. 13 received allogenic BMT and 11 autologous BMT. All the 7 girls, whatever the types of preparations and BMT, developed severe ovarian failure. Of the 17 boys, all 5 who have received previously testicular irradiation for ALL relapse and TBI before BMT have evidences of leydigian dysfunction (Δ). The evolution of the others 12 is summarized in the table according the status of puberty and conditioning regimens. Of the 9 given chemotherapy only, 3 were prepubere at BMT and 2 of these developed Sertolian dysfunction. In conclusion, this study confirms the constant ovarian dysfunction after BMT in girls. For the boys even in the group of patients given only chemotherapy there was evidence of secondary testicular dysfunction regardless of the respective timing ot BMT and the onset of puberty.