EARLY HIGH-DOSE CHEMOTHERAPY INTENSIFICATION WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN LYMPHOMA ASSOCIATED WITH RETENTION OF FERTILITYAND NORMAL PREGNANCIES IN FEMALES
Gh. Jackson et al., EARLY HIGH-DOSE CHEMOTHERAPY INTENSIFICATION WITH AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN LYMPHOMA ASSOCIATED WITH RETENTION OF FERTILITYAND NORMAL PREGNANCIES IN FEMALES, Leukemia & lymphoma, 28(1-2), 1997, pp. 127-132
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.