Autologous haematopoietic stem cell transplantation (aHSCT) is increasingly taken into consideration as a treatment strategy for patients with aggressive multiple sclerosis (MS). The chemotherapies used in the conditioning regimens for aHSCT are known to be responsible of amenorrhea in fertile women. Therefore, concerns on successful family planning in women with aggressive MS treated with aHSCT might rise.
To assess fertility outcomes in women treated with aHSCT for aggressive MS considering different conditioning regimens.
We collected disease- and treatment-related characteristics from consecutive women with MS treated with aHSCT at the Italian MS centers of Genoa, Barletta and Cagliari. ANCOVA analyses and binary logistic regression were performed to assess the effects of baseline characteristics on fertility outcomes.
We included 38 women [25(67%) with relapsing-remitting MS] with a mean age at aHSCT of 31.7(±6.7) years and a mean disease duration of 10.9(±6.0) years. Mean age of menarche was 12.3(±1.9) years. 31(82%) patients underwent transplant with a myeloablative cconditioning regimen while 7(18%) patients were transplanted with a low-intensity lymphoablative regimen. 26(68.4%) patients recovered menstrual cycle after a mean time of 5.7(5.2) months. Among these, 10(38%) patients had irregular periods (<21days;>35days apart) and 11(42%) had changes in the menstrual flow. Patients who recovered menstrual cycle were younger at the time of transplant (28.8vs37.7 years;p<0.0001) and had lower EDSS scores 1 year before aHSCT (4.7vs5.8;p=0.024). No significant differences were noted in terms of clinical phenotypes, age of menarche, body mass index, number of previous therapies, previous exposure to cyclophosphamide, mitoxantrone and the conditioning regimen used within aHSCT. A younger age was independently associated with a higher probability of recovery of menstrual cycle (OR=0.78;p=0.006). 3/27 patients (11%) with ≤35 years had persistent amenorrhea after aHSCT. We recorded 4 pregnancy after aHSCT (3 uncomplicated pregnancies and 1 spontaneous abortion). One patient repeatedly tried to conceive, both naturally and artificially, without success.
Younger age is independently associated with the recovery of menstrual cycle in women with MS treated with aHSCT, which is obtained in 89% of women under 35 years old. The use of a myeloablative conditioning regimen doesn’t seem to be associated with worse fertility outcomes.