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KMID : 1007320070130010008
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Journal of the Korean Society of Menopause
2007 Volume.13 No. 1 p.8 ~ p.13
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Hormone Replacement Therapy following Stem Cell Transplant
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Lee Byoung-Ick
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Abstract
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Women undergoing stem cell transplantation (SCT) are mostly young and have more than 90% probability of ovarian failure, which is often permanent. A woman’s age, use of radiotherapy, alkylating chemotherapy, and the allogeneic type of transplant are associated with a higher rate of premature ovarian failure (POF) and worse residual ovarian function. POF has serious systemic and psychological effects that may need treatment and should be managed by practitioners trained to treat this particular population of women. Ultrasonographic evidence of ovarian follicles is often associated with a future resumption of cycles, but there are no serum markers to predict the return of ovarian function in these patients. There are no guidelines on how to manage POF induced by myeloablative treatments followed by SCT. Because of the likelihood of the need for long-lasting estrogen plus progestin therapy (EPT) and the increased risk of secondary neoplasia after SCT, the EPT should be as physiological as possible. The cyclical sequential combination of EPT was associated with excellent compliance because of its simple administration and few adverse effects. Such a treatment led to a dramatic improvement in vasomotor, urogenital, and psychological symptoms related to estrogen deficiency. However, in the allogeneic transplantation setting, up to 25% of women may suffer from gynecological chronic graft-versus-host disease (GVHD), which may become apparent as hematocolpometra after introduction of EPT. Thus, accurate pretreatment evaluation and frequent monitoring during treatment are required. Moreover, EPT absorption may be reduced in patients who received allotransplants and have gastrointestinal or skin chronic GVHD.
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KEYWORD
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Stem cell transplantation, Hormone replacement therapy
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