Ovarian function after autologous bone marrow transplantation in childhood: high-dose busulfan is a major cause of ovarian failure

We studied pubertal status and ovarian function in 21 girls aged 11-21 year s who had earlier received 1.2-13 years (median 7 years) high-dose chemothe rapy and autologous BMT without TBI for malignant tumors. Ten of them were given busulfan (600 mg/m(2)) and melphalan (140 mg/m(2)) with or without cy clophosphamide (3.6g/m(2)). Eleven others did not receive busulfan, Twelve girls (57%) had clinical and hormonal evidence of ovarian failure. Among ni ne others who had completed normal puberty, six had normal gonadotropin lev els, one had elevated gonadotropin levels and two had gonadotropin levels a t the upper limit of normal. The 10 girls who received busulfan all develop ed severe and persistent ovarian failure. High-dose busulfan is therefore a major cause of ovarian failure even when given in the prepubertal period, These findings emphasize the need for long-term endocrine follow-up of thes e patients in order to initiate estrogen replacement therapy.