Background
Methods
Gynaecological complications of HSCT
POF
Patient relating factor | |
Pubertal stage | Postpuberal > prepuberal |
Age of HSCT | >30 years |
Underlying disease | ALL, lymphomas |
Treatment relating factor | |
Type of radiotherapy | TBI, pelvic, inverted Y, fractionated doses |
Chemotherapy | Alkylating agents > other chemotherapy |
Type of transplant | Allo-HSCT > auto-HSCT |
HSCT complications | Presence of GVHD |
Thrombocytopenia-associated menorrhagia
Genital symptoms of cGVHD
Osteoporosis
Secondary solid tumours
Fertility and pregnancy issues
Ovarian tissue cryopreservation
GnRH analogues
A clinic protocol for the management of gynaecological complications before and after HSCT
Diagnostic work-up before HSCT
Anthropometric Characteristics | • Age |
• Height | |
• Weight | |
• BMI | |
Haematological Data | • Kind of haematological malignancy |
• Kind, onset and duration of conditioning regimen | |
• Serum Ferritin levels | |
• Haemoglobin | |
Thrombotic Risk | • Previous thrombotic disease |
• PT, PTT, ATIII, fibrinogen | |
• Platelet Count | |
Bone Evaluation | • MOC-DEXA of the vertebral district and of the right and left femur |
Gynaecological Features | • Age at menarche |
• Spontaneous Menarche | |
• Menses Regularity | |
• Primary or Secondary Amenorrhea | |
• Estro-progestins replacement therapy | |
• Previous pregnancies | |
• History of pelvic infections/inflammations | |
• Gynaecological Examination | |
• Pelvic ultrasound scan evaluating uterine size, endometrial thickness, ovarian size | |
• HPV-test | |
Reproductive Features | • FSH, LH, estradiol (E2), prolactin (PRL), anti-mullherian hormone (AMH), and thyroid profile (TSH, fT3, fT4, anti-TPO, anti-TBG) |
• Antral Follicle Count (AFC)a
| |
• Onco-fertility counselling |