Long-term follow-up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies
Long-term follow-up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies
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DOI：
10.1111/ejh.12317
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发表时间：
2014-08-01
影响因子：
3.1
通讯作者：
Landgren, Britt-Marie
中科院分区：
文献类型：
--
作者：
Naessen, Sabine;Bergstrom, Ingrid;Landgren, Britt-Marie
本研究的目的是评估卵巢功能，生育能力和骨密度的妇女谁以前有不同的血液系统恶性肿瘤（HM）的治疗。HM患者的总体生存率和治愈率显著提高。这种治疗会影响生育能力和骨密度。来自斯德哥尔摩地区的52名绝经前妇女在1998年至2002年期间被纳入研究，随访至2011年。诊断为急性淋巴细胞白血病（n = 6）、急性髓性白血病（n = 10）、慢性淋巴细胞白血病（n = 1）、慢性髓性白血病（n = 12）、霍奇金淋巴瘤（n = 12）和非霍奇金淋巴瘤（n = 11）。在治疗前，如果可能的话，为没有孩子的妇女（43/52）提供生育保留选择。诊断时平均年龄为27岁，最后评估时平均年龄为39岁。37例患者接受了HSCT; 26例同种异体，11例自体。在异基因造血干细胞移植前，19例患者进行了清髓性预处理，7例进行了低强度预处理。11例患者接受全身照射。8例患者移植了来自HLA相同的同胞供体的移植物，而18例患者移植了无关的供体。所有女性在治疗后均处于绝经状态。给予激素替代治疗（HRT），每隔一年测量一次骨密度（BMD）。血清甲状旁腺激素（PTH）、游离钙和结合钙均在正常范围内。BMD测量显示脊柱随时间推移略有增加，平均值为0.015 g/cm（2）/年。四个自发怀孕导致两个婴儿和两个中止怀孕;两个怀孕是通过卵母细胞捐赠和代孕实现的，一个女人收养了一个孩子。HRT可维持HM长期幸存者的骨密度。这项研究强调了HRT和生育问题在这一患者群体中的重要性。
The purpose of this study was to assess the ovarian function, fertility and bone mineral density in women who previously had treatment for different haematological malignancies (HMs). The overall survival and cure rates of patients with HMs have improved dramatically. The treatment affects fertility and bone density. Fifty-two premenopausal women, from Stockholm region, were included in the study between 1998 and 2002, followed until 2011. The diagnoses were acute lymphoblastic leukaemia (n = 6), acute myeloid leukaemia (n = 10), chronic lymphocytic leukaemia (n = 1), chronic myeloid leukaemia (n = 12), Hodgkin lymphoma (n = 12) and non-Hodgkin lymphoma (n = 11). Before treatment, women without children (43/52), when possible, were offered fertility preservation options. The mean age at diagnosis was 27, at final evaluation 39 yr. Thirty-seven patients received HSCT; 26 allogeneic, 11 autologous. Before allogeneic HSCT, nineteen patients had myeloablative conditioning; seven had reduced-intensity conditioning. Eleven patients got total body irradiation. Eight patients were transplanted with grafts from an HLA-identical sibling donor, while 18 had unrelated donors. All women were in a menopausal state post-therapy. Hormone replacement therapy (HRT) was given, and bone mineral density (BMD) was measured every other year. The serum levels of parathyroid hormone (PTH), free and bound calcium was within normal range. BMD measurements showed a slight increase over time in the spine with a mean of 0.015 g/cm(2)/yr. Four spontaneous pregnancies resulted in two babies and two discontinued pregnancies; two pregnancies were achieved with oocyte donation and surrogacy and one woman adopted a child. HRT sustains BMD in long-term survivors from HMs. This study highlights the importance of HRT and fertility issues in this patient group.