Brigitte Gerstl1,2, Elizabeth Sullivan3, Jana Koch1, Handan Wand1, Angela Ives4, Richard Mitchell2,5, Nada Hamad6, Antoinette Anazodo7,8,9. 1. Department of Biostatistics, The Kirby Institute, University of New South Wales, Kensington, NSW, Australia. 2. Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, NSW, 2031, Australia. 3. Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. 4. Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, WA, Australia. 5. School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Randwick, NSW, Australia. 6. Department of Haematology, The Kinghorn Cancer Centre, St Vincent's Hospital, Darlinghurst, NSW, Australia. 7. Kids Cancer Centre, Sydney Children's Hospital, Randwick, Sydney, NSW, 2031, Australia. Antoinette.anazodo@health.nsw.gov.au. 8. School of Women's and Children's Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Randwick, NSW, Australia. Antoinette.anazodo@health.nsw.gov.au. 9. Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia. Antoinette.anazodo@health.nsw.gov.au.
Abstract
PURPOSE: The use of high-dose chemotherapy and radiotherapy combined with haematopoietic stem cell transplantation (HSCT) may negatively affect a woman's reproductive potential. Reproductive outcomes such as infertility are a major concern for women who undergo treatment for a haematological cancer diagnosis. OBJECTIVE: This systematic review and meta-analysis explores reproductive outcomes following a haematological cancer requiring HSCT. METHODS: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a haematological cancer diagnosis. Studies were included that reported on pregnancy and reproductive outcomes following HSCT for a haematological malignancy. RESULTS: The meta-analysis included 14 studies, collectively involving 744 female patients. The subgroup analysis showed an overall pooled estimated pregnancy rate, for autologous or allogeneic HSCT recipients, of 22.7% (n = 438). There were 25% (n = 240) of women who became pregnant after autologous HSCT compared with 22% (n = 198) who subsequently became pregnant following allogeneic HSCT. CONCLUSIONS: This meta-analysis reflects low pregnancy rates for cancer survivors desiring a family. However, live births are improving over time with new technology and novel therapies. Hence, female cancer patients should be offered timely discussions, counselling and education around fertility preservation options prior to starting treatment with gonadotoxic therapy.
PURPOSE: The use of high-dose chemotherapy and radiotherapy combined with haematopoietic stem cell transplantation (HSCT) may negatively affect a woman's reproductive potential. Reproductive outcomes such as infertility are a major concern for women who undergo treatment for a haematological cancer diagnosis. OBJECTIVE: This systematic review and meta-analysis explores reproductive outcomes following a haematological cancer requiring HSCT. METHODS: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a haematological cancer diagnosis. Studies were included that reported on pregnancy and reproductive outcomes following HSCT for a haematological malignancy. RESULTS: The meta-analysis included 14 studies, collectively involving 744 female patients. The subgroup analysis showed an overall pooled estimated pregnancy rate, for autologous or allogeneic HSCT recipients, of 22.7% (n = 438). There were 25% (n = 240) of women who became pregnant after autologous HSCT compared with 22% (n = 198) who subsequently became pregnant following allogeneic HSCT. CONCLUSIONS: This meta-analysis reflects low pregnancy rates for cancer survivors desiring a family. However, live births are improving over time with new technology and novel therapies. Hence, female cancerpatients should be offered timely discussions, counselling and education around fertility preservation options prior to starting treatment with gonadotoxic therapy.
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