Spontaneous pregnancies in female survivors of childhood allogeneic haemopoietic stem cell transplants for hematological malignancies.

Spontaneous pregnancies and live births are rarely reported after hematopoietic stem cell transplant (HSCT). We report spontaneous pregnancy outcomes of sexually active female survivors of childhood allogeneic HSCT, to provide more data for future counselling.Retrospective review of all female survivors of childhood hematological malignancies who had allogeneic HSCT at the Royal Children Hospital between 1985 and 2011. Data was retrieved from medical records, updates from treating hematologist or endocrinologist, and was cross-referenced with self-reported questionnaires. Female survivors who were sexually inactive were excluded from analysis.Six of 37 (16.2%) female survivors reported spontaneous pregnancies resulting in 8 live-births. Among 22 women who received total body irradiation (n=21) +/- cranial irradiation or isolated cranial irradiation (n=1), and high dose cyclophosphamide, three reported pregnancy resulting in live-births (14%), whilst three of 15 women who received chemotherapy alone had pregnancy with live-births (20%).Our current finding, albeit a small sample size, reinforces the importance of counselling female survivors of HSCT about the possibility of spontaneous pregnancy occurring despite documented ovarian failure and for need of contraception to avoid unplanned pregnancy.

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