Severe adverse impact on sexual functioning and fertility of bone marrow transplantation, either allogeneic or autologous, compared with consolidation chemotherapy alone - Analysis of the MRC AML 10 trial

BACKGROUND. Data relating to the impact of bone marrow transplantation (BMT ) on sexual functioning are equivocal; some studies have shown no major imp act whereas others demonstrate a significant adverse effect on sexual healt h in patients treated with BMT. Further clarification is required to facili tate treatment choices and follow-up management of patients. METHODS. A cross-sectional study of sexual health and infertility was condu cted in 479 patients with acute myeloid leukemia (AML) in first complete re mission (CR) who were entered into the UK MRC AML 10 trial comparing alloge neic BMT (Allo-BMT), autologous BMT (A-BMT), and intensive consolidation ch emotherapy (CCT). Assessment was made by patient questionnaire via the trea ting centers for completion and returned directly to the coordinating cente r. RESULTS. Both Allo-BMT and A-BMT were observed to have severe, highly signi ficant adverse effects on the patients' sexual health. Significantly more B MT patients than CCT patients reported a decrease in interest in sex (48% v s. 24%), sexual activity (53% vs. 35%), pleasure from sex (36% vs. 18%), an d ability to have sex (38% vs. 18%) (P < 0.001 in each case). Hormonal diso rders and infertility also were more common in BMT patients than in CCT pat ients. These differences were more apparent in women and remained after adj ustment for age. CONCLUSIONS. These results indicate a need to consider quality of life para meters when reviewing treatment options and to instigate effective proactiv e management strategies for dealing with sexual health problems in leukemia survivors. Cancer 1999;86:1231-9. (C) 1999 American Cancer Society.