Chances of fertility recovery ‘substantial’ following ASCT and BEAM

Blood cancers

By Amanda Sheppeard

4 Feb 2016

Research examining fertility outcomes in in pre-menopausal women undergoing BEAM/ASCT for lymphoma has found ‘substantial’ incidence of recovery of menses and fertility, particularly in younger women.

The retrospective analysis, published online in the European Journal of Haematology  highlighted the importance of fertility counselling for patients about to undergo the treatment, said lead author Dr Masa Lasica, of the Austin Hospital’s Haematology Department.

She said the analysis was a useful addition to the existing minimal data on fertility outcomes in pre-menopausal women undergoing autologous stem cell transplant (ASCT) with carmustine, etoposide, cytarabine and melphalan (BEAM) conditioning.

“So far, there has been a paucity of data on fertility outcomes after autologous stem cell transplant with BEAM conditioning in patients without exposure to alkylating agents prior to the autograft,” she told the limbic.

“Our data will hopefully be a useful tool in pre-transplant counselling not only regarding risk of infertility and premature menopause but also the importance of contraception.”

The analysis looked at fertility outcomes in pre-menopausal females aged between 18 and 40 years who underwent BEAM/ASCT for lymphoma between 1995 and 2011, at four transplant centres.

Of the 25 women who met the inclusion criteria, 18 had Hodgkin lymphoma (HL) and seven had non-Hodgkin lymphoma (NHL).

Of these, 17 women (68%) with a median age at transplant of 25 years recovered their menses. The comparative group without recovery was older with a median age of 34 years, while 10 patients, with a median age at transplant of 22 years (range 17-30), had 15 naturally conceived pregnancies.

“Chemotherapy regimens and lymphoma type did not obviously influence the incidence of menses recovery or conception,” the authors wrote.

“The incidence of recovery of menses and fertility in pre-menopausal women undergoing BEAM/ASCT for lymphoma is substantial. Younger age at transplant correlates with superior fertility outcomes.”

While the data suggests that there is a reasonable chance of menses recovery especially in the younger age bracket, women undergoing these treatments were undoubtedly at a greater risk of premature ovarian failure than the average population within the same age group.

“Fertility preservation is therefore an important consideration,” Dr Lasica said.

She said the study was limited by population size and the retrospective nature of the research and “a prospective, larger study including data on endocrine and ultrasonographic assessment of ovarian reserve may be useful.”

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