MON-LB041 Hematopoietic Stem Cell Transplantation in Childhood and Successful Pregnancies in Survivors: A Single Center Experience

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for a variety of malignant and non-malignant disorders. The prevalence of HSCT survivors continues to increase. Gonadal insufficiency and infertility are amongst the most frequent late complications. Methods: Data on successful pregnancies following HSCT in childhood were analyzed in 180 patients older 18 years (all transplanted at our center). Median age at the time of HSCT was 15.5 (8.0 - 19.9) years. Results: 25 of 180 (14%) subjects (males=14, females=11) became parents. Of them non-malignant severe aplastic anemia (SAA) had 12 (48%) subjects and another 13 had malignant diagnosis: acute lymphoblastic (ALL; n=6), acute myeloid (AML; n=1) and chronic myeloid (CML; n=3) leukemia; remaining 3 patients had myelodysplastic syndrome (MDS). Forty children were born to the overall group, 34 out of 40 (85%) in term, all were healthy. First pregnancy (both spontaneous or after assisted reproduction) was documented 10.4 (2.5 - 24) years after HSCT in patient´s median age 26.3 (18.3 - 41.2) years. Spontaneous gravidity was detected in 16 subjects (males=9, spermiogram evaluated in 8 of them; females= 7, spontaneous regular menstrual cycle had 5 of them). Majority of subjects had HSCT due to SAA (75%; 7 males and 5 females) with cyclophosphamide regimen only. In 2 males full myeloablative Busulphan based conditioning was used (MDS, AML), and 2 females (MDS and CML, both with hormonal replacement therapy and possibility of some residual oocyte reserve) become pregnant after previously repeated unsuccessful assisted reproduction techniques (ART) with ovarian hyperstimulation (even one after total body irradiation 14.4 Gy based regimen). In remaining 9 subjects successful pregnancy was achieved after ART (donor sperm=1, cryopreserved sperm =2, TESE=2, donor oocytes=4). Conclusions: Gonadotoxicity after HSCT and infertility are the well-known posttransplant complications negatively affecting the quality of life. Fertility issues must be routinely discussed at peritransplant care. In the field of reproductive medicine impressive advances have been achieved to offer the best option for fertility preservation and pregnancy outcome. Better knowledge of pregnancy rate especially in pediatric population following HSCT will require more data for analysis in international cooperation. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.