Reproductive status in long-term bone marrow transplant survivors receiving busulfan-cyclophosphamide (120 mg/kg)

There are few published data on the recovery of fertility after 'little' Bu -Cy (busulfan 16 mg/kg, cyclophosphamide 120 mg/kg) conditioning for BMT, T o address this, we identified 19 females aged less than 40 years at transpl ant and 47 males from a single centre who were alive a minimum of 2 years a fter BMT with little Bu-Cy as conditioning and who were evaluable for testi ng. FSH, LH, testosterone and inhibin B levels were measured in males. Twen ty-six also had semen analysis, a median of 5 years post transplant; 21 had detectable sperm, with 11 having counts >20 x 10(6)/ml. There was an assoc iation between prolonged chronic graft-versus-host disease and low sperm co unts. FSH and inhibin B levels correlated with sperm counts but not to the extent that they could reliably predict counts in individual patients. An a dditional six of seven males attempting to father children did so, a median of 3.2 years post transplant. Low testosterone levels were noted in 12% of males, most of whom had symptoms consistent with androgen deficiency. FSH, LH and oestradiol levels in the absence of hormone replacement therapy wer e measured in females; all remained amenorrheic with endocrine evidence of ovarian failure. These results have implications for fertility counselling and hormone replacement therapy both pre- and post BMT.