Development of institutional guidelines for menstrual suppression and abnormal uterine bleeding in patients undergoing intensive chemotherapy for hematologic malignancies.

PURPOSE: Bleeding complications significantly contribute to morbidity and mortality of patients with hematologic malignancies. Although there is some evidence for treatment and prevention of uterine bleeding in patients with cancer, there is no specific guidance used universally for hematologic malignancies. This study evaluated prescribing patterns of agents used for treatment and prevention of uterine bleeding in patients receiving intensive chemotherapy for hematologic malignancies to provide guidance for a standardized approach for treatment and prevention of uterine bleeding within a single health system.

METHODS

Evaluation of prescribing patterns was performed via a dual-center, retrospective chart review of patients receiving intensive chemotherapy for hematologic malignancies and receiving preventative therapies, and/or treatment for uterine bleeding between January 1, 2018, and September 1, 2021. A guideline for the health system was drafted based on an assessment of results.

RESULTS

A total of 91 patients were evaluated. For prevention of uterine bleeding, 68% of patients received leuprolide acetate alone. For treatment of uterine bleeding, 25% of patients required initiation of and/or increased doses of medroxyprogesterone. Fifty-seven percent of patients with uterine bleeding had adjustment of their baseline platelet transfusion goal from ≥ 10 K/cu mm to a goal of ≥ 20 K/cu mm or greater.

CONCLUSIONS

Based on data from the retrospective chart review, an institutional guideline was created, including recommendations for patients to receive a 3-month formulation of leuprolide acetate with concomitant oral medroxyprogesterone at 20 mg/day for prevention of uterine bleeding. Further prospective studies are needed to determine optimal strategies for prevention and treatment of uterine bleeding in this patient population.