EARLY HIGH-DOSE CHEMOTHERAPY INTENSIFICATION WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN LYMPHOMA ASSOCIATED WITH RETENTION OF FERTILITYAND NORMAL PREGNANCIES IN FEMALES

As more centres consider autologous bone marrow and peripheral blood s tem cell transplantation for patients with high risk Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL) in first complete remission (CR 1) the long term sequelae of such treatments have to be considered, On e of the most important side effects of such intensive treatment is lo ss of fertility. Sperm banking before treatment commences is available for males but unfortunately cryopreservation of ova/ovarian tissue is not yet possible for females. We have transplanted 30 women, 23 were under 40 years and report ten females who have had successful pregnanc ies (including two twin pregnancies and one triplet pregnancy), leadin g to live births following autologous bone marrow transplantation (ABM T) for poor prognosis HD and NHL in first or second complete remission . None of these children have shown evidence of birth defects (median follow up of two years). Of the twenty one pregnancies reported to the European Bone Marrow Transplantation Registry (EBMTR) following ABMT for lymphoma, eight of the seventeen unassisted cases came from our ce ntres. The Newcastle/SNLG autotransplant differs from the approach in many EBMTR centres in that it uses melphalan or melphalan/etoposide al one instead of the more common four drug containing regimens and yet s ustained complete remission rates indicate that the non-ablative appro ach is equally effective as more aggressive regimens on the disease wi th the huge advantage of preserved fertility in females. This approach to conditioning for ABMT should be considered when treating women in the reproductive age group.