Long-term follow-up of fertility and pregnancy in autoimmune diseases after autologous haematopoietic stem cell transplantation
| Autor: | G.-R. Burmester, Gero Massenkeil, Bernd Dörken, Oliver Rosen, Tobias Alexander, Renate Arnold, Falk Hiepe, Andreas Radbruch |
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| Rok vydání: | 2016 |
| Předmět: |
Infertility
Adult Male medicine.medical_specialty Pediatrics Cyclophosphamide Pregnancy Rate media_common.quotation_subject Immunology Fertility Primary Ovarian Insufficiency Autoimmune Diseases 03 medical and health sciences Young Adult 0302 clinical medicine Rheumatology immune system diseases Pregnancy Internal medicine medicine Immunology and Allergy Humans media_common 030203 arthritis & rheumatology Lupus erythematosus business.industry Hematopoietic Stem Cell Transplantation Pregnancy Outcome Middle Aged medicine.disease Premature ovarian failure Transplantation surgical procedures operative Female Follicle Stimulating Hormone business Immunosuppressive Agents 030215 immunology medicine.drug Follow-Up Studies |
| Zdroj: | Rheumatology international. 36(11) |
| ISSN: | 1437-160X |
| Popis: | Issues of fertility and pregnancy require special attention in the long-term care of patients with autoimmune diseases (AD), who are candidates for haematopoietic stem cell transplantation (HSCT). In this single-centre observational study, we report fertility status and pregnancy outcomes in 15 patients (11 female and 4 male) after immunoablation with cyclophosphamide, antithymocyte globulin and autologous CD34+—selected HSCT for severe, refractory AD. The median follow-up after HSCT was 12 years (range 2–16 years). Impaired fertility was observed in six patients (five females and one male) before HSCT based on sexual hormone measurements. Higher age and cumulative cyclophosphamide dosage before HSCT correlated with fertility impairment. Median serum level of follicle-stimulating hormone (FSH) was significantly higher in female patients at 1 year after HSCT compared to baseline values, but premature ovarian failure developed in only one patient. Four women had five pregnancies and six healthy offsprings during follow-up, and no miscarriages were observed. The mothers were in treatment-free remissions during conception. No peripartal flare of their AD occurred. Although AD patients undergoing HSCT are at risk of developing infertility, pre-HSCT treatment and patients’ age seem to have higher impact on long-term fertility status than HSCT itself. HSCT offers the opportunity to conceive during treatment-free remissions with favourable pregnancy outcomes. |
| Databáze: | OpenAIRE |
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