Alkylating agent-associated fertility impairment in female adolescents and young adults with acute leukemia.

BACKGROUND: The long-term survival rate of female adolescent and young adults (AYAs) with acute leukemia (AL) is improving. Thus, preserving the possibility of pregnancy has gained priority among this population. However, the data on the reproductive outcomes among AYA AL survivors are limited. Our study aimed to identify the incidence of long-term menstruation status and natural pregnancy among AYA AL survivors receiving chemotherapy regimens with or without hematopoietic stem cell transplantation (HSCT).

METHODS: We retrospectively assessed the pregnancy and live birth rate of patients with AL admitted to The First Affiliated Hospital, Zhejiang University School of Medicine, from December 1, 2013, and August 25, 2019. A total of 150 patients aged 15-35 years were included. The patient group consisted of 78 patients with AL with a median age of 25.9 years [interquantile range (IQR), 15.6-34.5 years], while the control group consisted of 72 patients with acute promyelocytic leukemia (APML) with a median age of 25.1 years (IQR, 15.8-34.7 years).

RESULTS: The number of pregnancies (3 vs. 16) and live births (2 vs. 17) was higher in the control group than in the AL group. Among the patient group, 60 (76.9%) experienced acute ovarian failure (AOF), and 8 patients (10.3%) reported oligomenorrhea. Moreover, in the AOF subgroup, 57 patients underwent HSCT, and 3 underwent chemotherapy only. A cyclophosphamide equivalent dose (CED) ≥3,410 mg/m2 was found to be closely associated with AOF.

CONCLUSIONS: Our study provides a more comprehensive fertility profile for AYA patients with AL and evidence-based support for fertility preservation consultation in this patient group.