Preservation of ovarian function by ovarian shielding when undergoing total body irradiation for hematopoietic stem cell transplantation: a report of two successful cases

• Published in: Bone marrow transplantation (Basingstoke) Vol. 37; no. 6; pp. 583 - 587
• Main Authors: Nakagawa, K, Kanda, Y, Yamashita, H, Hosoi, Y, Oshima, K, Ohtomo, K, Ban, N, Yamakawa, S, Nakagawa, S, Chiba, S
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.03.2006
• Subjects: 17β-Estradiol; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Combined Modality Therapy; Computed tomography; Estradiol - blood; Female; Follicle-stimulating hormone; Health aspects; Hematopoietic stem cells; Humans; Irradiation; Leukemia; Leukemia - therapy; Medical sciences; Menstruation; Ovaries; Ovary - radiation effects; Patients; Phantoms, Imaging; Posture; Preservation; Prone position; Radiation; Radiation dosage; Radiation Protection - methods; Reproductive status; Sex hormones; Shielding; Stem cell transplantation; Stem Cell Transplantation - methods; Stem cells; Supine position; Tomography, X-Ray Computed; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Whole-Body Irradiation - methods; Japan; Case study; Ovary; Total body irradiation; Hematology; Preservation; Stem cell; Female genital system; Hematopoietic cell; Graft; ovarian shielding;stem cell transplantation; ovarian function
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705279

The purpose of this study was to evaluate the possibility of preserving ovarian function by ovarian shielding to reduce the irradiation dose in total body irradiation (TBI). The subjects in the study were females aged less than 40 years, who were undergoing allogeneic hematopoietic stem cell transplantation using a TBI-based regimen and who desired to have children after transplantation. For ovarian shielding, abdominal computed tomography (CT) and skin marking were performed in both the supine and prone positions, prior to the TBI. A pair of columnar blocks was placed just above the patient's body. Thus far three patients have been treated. The serum estradiol level decreased to an undetectable level (<8.5 pg/ml) after transplantation and the follicle-stimulating hormone (FSH) level increased above 90 mIU/ml in all patients and they became amenorrheic. However, regular menstruation recovered in patients no. 1 and 2 about 800 and 370 days after transplantation, respectively, with a decrease in the serum FSH level. Menstruation did not recover in patient no. 3, and serum estradiol was transiently detected above 20 pg/ml. The preservation of ovarian function was made possible by ovarian shielding. However, a longer follow-up is needed to know if normal pregnancy and delivery can occur.