Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: A pilot study

Vaginal bleeding during aplasia can induce transfusion support, infection a nd discomfort. Oral and intramuscular hormonotherapy can be toxic and/or di fficult to manage (mucositis). This single-center pilot study evaluated the efficacy and safety of leuprorelin (L) in preventing heavy vaginal bleedin g in 20 nonmenopausal women with leukemia, lymphoma or myeloma and foreseab le therapy-induced thrombocytopenia. Until platelet recovery, patients rece ived subcutaneous injections of L, with concomitant nomegestrol acetate (NA ) during the first 35 days to prevent flare-up. Median age was 33 years (18 - 48). Platelet nadir was < 20 x 10(9)/1 in 17 patients; 103 L injections were performed (median per patient: 4 [1 - 14]). No moderate or severe adverse event was related to hormonal therapy. Seven teen patients did not experience any clinically or therapeutically relevant bleeding. Eleven spottings and 8 metrorrhagias (mean duration : 3 days) oc curred in I I patients, requiring enhanced NA in 3 cases (baseline platelet count was < 20 x 10(9)/1 in 1 pt, premature termination of NA [the single platelet transfusion for metrorrhagia] in 1 pt, and endometrial hyperplasia (EH) in the third). In patients without EH, only 5 spottings were observed after the third injection, without neither clinical nor therapeutic impact (63 injections). In conclusion, leuprorelin administration is safe and eff ective in preventing vaginal bleeding. The sustained-release form and subcu taneous administration offer quality of life advantages.