Recovery of gonadal function and fertility is better with 2-day RIC regimen following HCT

Patients who require hematopoietic cell transplantation (HCT) and receive busulfan in a 2-day reduced-intensity conditioning (RIC) regimen have a greater chance of recovery of gonadal function than those undergoing myeloablative conditioning (MC) using busulfan for 4 days, results of a study have shown.

One of the major quality of life concerns in patients successfully treated with HCT is recovery of sexuality and fertility, noted Young-Shin Lee, RN, OCN®, MSN, and colleagues from the Asan Medical Center, Seoul, Republic of Korea. Common problems among patients who receive myeloablative conditioning regimens include gonadal dysfunction and infertility; however, few data have described problems in those receiving reduced-intensity conditioning regimens, they reported during the Oncology Nursing Society 36th Annual Congress.

This study sought to compare recovery from gonadal dysfunction and infertility following allogeneic HCT in patients receiving busulfan (4 mg/kg/d orally or 3.2 mg/kg/d IV) in either a 4-day MC regimen or a 2-day RIC regimen as conditioning therapy. The study included 53 patients (43 male, 10 female) 50 years or younger without relapse of their underlying disease over a 2-year period following HCT. Patients were surveyed with respect to pregnancies, semen analysis, and pelvic ultrasonography. Blood levels of follicle-stimulating hormone (FHS), luteinizing hormone (LH), and testosterone were also assayed.

Blood levels of FSH and LH in males receiving the busulfan 2-day RIC regimen (n=22) were found to be significantly lower than those receiving the busulfan 4-day MC regimen (n=21) (P = .003 and P = .018, respectively), whereas testosterone levels were similar in both groups (P = .817). In addition, sperm counts were significantly higher in those receiving the 2-day regimen (P = .017). Three patients in each group reported pregnancies of their partners.

Fewer differences between the conditioning regimens were observed among the 10 females in the study, nine of whom received the 4-day MC regimen and one, the 2-day RIC regimen. Of these 10 patients, only the one patient who received the 2-day regimen reported natural menstruation and had normal blood levels of FSH, LH, and estradiol, and normal antral follicle counts and ovarian size as measured by pelvic ultrasonography. In contrast, none of the nine females who received the 4-day regimen reported natural menstruation or showed normal hormonal blood levels or normal pelvic ultrasonography findings.

The authors concluded that their data can help provide guidance in counseling patients receiving HCT about recovery of posttransplant sexuality and fertility.
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