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Reproductive outcomes following a stem cell transplant for a haematological malignancy in female cancer survivors: a systematic review and meta-analysis

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Abstract

Purpose

The use of high-dose chemotherapy and radiotherapy combined with haematopoietic stem cell transplantation (HSCT) may negatively affect a woman’s reproductive potential. Reproductive outcomes such as infertility are a major concern for women who undergo treatment for a haematological cancer diagnosis.

Objective

This systematic review and meta-analysis explores reproductive outcomes following a haematological cancer requiring HSCT.

Methods

Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a haematological cancer diagnosis. Studies were included that reported on pregnancy and reproductive outcomes following HSCT for a haematological malignancy.

Results

The meta-analysis included 14 studies, collectively involving 744 female patients. The subgroup analysis showed an overall pooled estimated pregnancy rate, for autologous or allogeneic HSCT recipients, of 22.7% (n = 438). There were 25% (n = 240) of women who became pregnant after autologous HSCT compared with 22% (n = 198) who subsequently became pregnant following allogeneic HSCT.

Conclusions

This meta-analysis reflects low pregnancy rates for cancer survivors desiring a family. However, live births are improving over time with new technology and novel therapies. Hence, female cancer patients should be offered timely discussions, counselling and education around fertility preservation options prior to starting treatment with gonadotoxic therapy.

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Authors and Affiliations

  1. Department of Biostatistics, The Kirby Institute, University of New South Wales, Kensington, NSW, Australia

    Brigitte Gerstl, Jana Koch & Handan Wand

  2. Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Sydney, NSW, 2031, Australia

    Brigitte Gerstl, Richard Mitchell & Antoinette Anazodo

  3. Office of the PVC Health and Medicine, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia

    Elizabeth Sullivan

  4. Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, WA, Australia

    Angela Ives

  5. School of Women’s and Children’s Health, Discipline of Paediatrics, UNSW Medicine, University of New South Wales, Randwick, NSW, Australia

    Richard Mitchell & Antoinette Anazodo

  6. Department of Haematology, The Kinghorn Cancer Centre, St Vincent’s Hospital, Darlinghurst, NSW, Australia

    Nada Hamad

  7. Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia

    Antoinette Anazodo

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  1. Brigitte Gerstl
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Contributions

BG and AA made substantial contributions to the conception and design. BG and JK were accountable for collection and assembly of data. NG, AA, HW and JK were responsible for data analysis. BG, AA, ES, NH, RM and AI were major contributors in drafting and writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Antoinette Anazodo.

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Gerstl, B., Sullivan, E., Koch, J. et al. Reproductive outcomes following a stem cell transplant for a haematological malignancy in female cancer survivors: a systematic review and meta-analysis. Support Care Cancer 27, 4451–4460 (2019). https://doi.org/10.1007/s00520-019-05020-8

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