International Journal of Hematology

DOI: 10.1007/s12185-019-02627-9 Pages: 578-583

High rates of ovarian function preservation after hematopoietic cell transplantation with melphalan-based reduced intensity conditioning for pediatric acute leukemia: an analysis from the Japan Association of Childhood Leukemia Study (JACLS)

1. Osaka Red Cross Hospital, Department of Pediatrics

2. Japan Association of Childhood Leukemia Study Group (JACLS)

3. Kyoto City Hospital, Department of Pediatrics

4. Hokkaido University, Department of Pediatrics

5. Miyagi Children’s Hospital, Department of Hematology and Oncology

6. Japanese Red Cross Nagoya First Hospital, Department of Hematology and Oncology, Children’s Medical Center

7. Osaka Women’s and Children’s Hospital, Department of Hematology/Oncology

8. Osaka City General Hospital, Department of Pediatric Hematology/Oncology

9. Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Department of Pediatrics

10. Okayama University, Department of Pediatrics

11. Osaka University, Department of Pediatrics

12. National Hospital Organization Osaka Medical Center, Department of Pediatrics

13. Osaka City University, Department of Medical Quality and Safety Science

14. Kobe University, Department of Pediatrics

15. Nagoya University, Department of Pediatrics

16. National Hospital Organization Nagoya Medical Center, Department of Pediatrics

Correspondence to:
Hisanori Fujino
Tel: +81-6-6774-5111



Women are at high risk of hypergonadotropic hypogonadism after hematopoietic cell transplantation (HCT). Hypogonadism is universal after irradiation or busulfan. We hypothesized that reduced intensity conditioning (RIC) might protect ovarian function after HCT. We retrospectively reviewed data from patients with acute leukemia treated according to the Japan Association of Childhood Leukemia Study and nationwide multicenter study protocol. We selected 11 female patients with acute leukemia who received first HCT with RIC, had survived for three or more years after HCT, and were aged ≥ 12 years at the last follow-up visit. Median age at diagnosis, HCT, and last visit were 8, 10, and 17 years. Six patients received HLA-matched bone marrow (BM), two HLA-mismatched BM, and three cord blood. Melphalan was used as conditioning regimen in all patients. At the last visit, six of seven post-pubertal patients at transplantation recovered menstruation, and four of four patients who underwent transplantation at the pre-pubertal began menstruation. Height z scores showed no significant reduction between pre-transplant and post-transplant. No patients received growth hormone treatment. Only one recipient displayed subclinical hypothyroidism. Melphalan-based RIC may be an encouraging option for patients with acute leukemia to avoid ovarian and endocrine dysfunction after HCT.

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