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Hypogonadism to varying degrees is common after allogeneic‐HCT, and myeloablative regimens quite frequently lead to permanent sterility [42]. TBI or busulfan‐based therapies are major risk factors. Detailed fertility risk–benefit discussions pre‐HCT in patients of child‐bearing age are strongly suggested. Hormonal insufficiencies may manifest as loss of libido, erectile dysfunction, vaginal dryness, and dyspareunia. Hormonal assessment at six months post‐HCT and then annually with follicle‐stimulating hormone (FSH), luteinizing hormone (LH), and estrogen in females and FSH, LH, and testosterone in symptomatic males is recommended.

For those patients who wish to conceive and do not have any evidence of hypogonadism, a general approach is to recommend conception planning after two years of HCT since the majority of the primary disease relapses occur within that period. Since some allogeneic‐HCT patients are given maintenance chemotherapies, contraception may be utilized (if gonadal function normal) during that period of maintenance therapy to avoid pregnancy since the majority of the agents currently utilized for this purpose are teratogenic (e.g., hypomethylating agents). Similarly, those patients who are undergoing GVHD therapy may benefit from contraception, too, due to unknown teratogenic effects (e.g., CNI, sirolimus). Use of tyrosine kinase inhibitors for the treatment of cGVHD or post‐HCT maintenance therapy is a contraindication for pregnancy due to their known teratogenicity.

Besides the above‐mentioned potential late pregnancy/ fetal complications, caution must be exercised during lactation since most of the GVHD therapy drugs (CNI) are excreted in breast milk.