bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2017-62-3-124-134bloodjour-74Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПАТОЛОГИЯ РЕПРОДУКТИВНОЙ СИСТЕМЫ ПОСЛЕ ТРАНСПЛАНТАЦИИ АЛЛОГЕННЫХ ГЕМОПОЭТИЧЕСКИХ СТВОЛОВЫХ КЛЕТОК У ДЕТЕЙ: ОПЫТ НАЦИОНАЛЬНОГО МЕДИЦИНСКОГО ИССЛЕДОВАТЕЛЬСКОГО ЦЕНТРА ДЕТСКОЙ ГЕМАТОЛОГИИ, ОНКОЛОГИИ И ИММУНОЛОГИИ им. Дм. РОГАЧЕВА МИНЗДРАВА РОССИИPATHOLOGY OF THE REPRODUCTIVE SYSTEM AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN CHILDREN: A SINGLE CENTER EXPERIENCEhttps://orcid.org/0000-0002-0566-053XСкворцоваЮ. В.SkvortsovaYu. V.

117997, г. Москва

Скворцова Юлия Валериевна, кандидат медицинских наук, старший научный сотрудник, врач-гематолог, зам. зав. отделением ТГСК №2

Moscow, 117997

Skvortsova Yulia V., MD, PhD,senior researcher, Deputy head of the Department Transplantation of hematopoietic stem cells Nо 2

yuscvo@mail.ruПапушаЛ. И.PapushaL. I.

117997, г. Москва

Moscow, 117997

https://orcid.org/0000-0001-6628-0760РудневаA. Е.RudnevaA. E.

117997, г. Москва

Moscow, 117997

https://orcid.org/0000-0001-7578-9657ВоронинК. A.VoroninK. A.

117997, г. Москва

Moscow, 117997

СкоробогатоваE. В.SkorobogatovaE. V.https://orcid.org/0000-0002-0016-6698МасчанA. A.MaschanA. A.

117997, г. Москва

Moscow, 117997

ФГБУ «Национальный медицинский исследовательский центр детской гематологии, онкологии и иммунологии им. Дм. Рогачева» Минздрава РоссииРоссияDmitry Rogachev National Research Center of Pediatric HematologyRussian FederationФГБУ «Российская детская клиническая больница» Минздрава РоссииРоссияRussian Children’s Research HospitalRussian Federation201712032019623124134Copyright © Скворцова Ю.В., Папуша Л.И., Руднева A.Е., Воронин К.A., Скоробогатова E.В., Масчан A.A., 20192019Скворцова Ю.В., Папуша Л.И., Руднева A.Е., Воронин К.A., Скоробогатова E.В., Масчан A.A.Skvortsova Y.V., Papusha L.I., Rudneva A.E., Voronin K.A., Skorobogatova E.V., Maschan A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/74

Трансплантация аллогенных гемопоэтических стволовых клеток (алло-ТГСК) в настоящее время позволяет вылечить ранее фатальные злокачественные и незлокачественные заболевания, количество выздоровевших от основной патологии детей неуклонно растет. Большой проблемой больных после алло-ТГСК становится развитие множества поздних осложнений. Среди них часто встречается патология функции гонад, что совместно с нарушением фертильности существенно влияет на дальнейшее качество жизни. Материал и методы. Приведен анализ состояния репродуктивной системы 294 детей, получивших алло-ТГСК на базе отделения трансплантации костного мозга ФГБУ Российской детской клинической больницы/Научного медицинского исследовательского центра детской гематологии, онкологии и иммунологии им. Дм. Рогачева (ранее Научно-исследовательский институт детской гематологии) с января 1994 г. по июль 2011 г. Медиана наблюдения составила 7,5 года. Результаты. Проблемы репродуктивной сферы были выявлены у 43 детей и подростков (15% от общей популяции и 46% в структуре эндокринной патологии). Основным нарушением явился гипергонадотропный гипогонадизм (33 больных, 77% репродуктивной дисфункции). Выявлены статистически значимые факторы риска его развития: бусульфан-содержащий режим кондиционирования (р < 0,001, риск развития гипогонадизма составил 26,7% в отличие от 5,2% при других режимах), диагноз злокачественного заболевания (р = 0,002, риск 26,6% при злокачественных заболеваниях и лишь 8,1% при незлокачественной патологии), облучение центральной нервной системы в анамнезе (p = 0,002, риск 32,6% при облучении в отличие от 15,6% без такового), женский пол (р = 0,003, риск возрастает в 3 раза – 26,9% у девочек против 9,3% у мальчиков). Также описаны случаи восстановления фертильности и деторождения. Приведен алгоритм диагностики и мониторинга патологии репродуктивной системы после алло-ТГСК у детей.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) nowadays allows cure malignant and nonmalignant diseases considered to be fatal previously. The number of cancer survivors’ children progressively increases over years. Unfortunately, numerous late effects of allo-HSCT become both a serious problem and a cause of the morbidity and mortality. Among them the reproductive pathology seems to be frequent, and fertility problems influence the quality of life of patients significantly. Material and methods. We present the results of the evaluation of reproductive system in 294 children after allo-HSCT. Reproductive problems were revealed in 43 children and adolescents (15% of all patients and 46% of the patients with endocrine pathology). Hypergonadotropic hypogonadism was the dominating problem (33 patients, 77% of all reproductive dysfunctions). Results. Risk factors of its development included: busulfan-containing conditioning regimen (р < 0.001, risk ratio (RR) of hypogonadism was 26.7% compared to 5.2% in other regimens), diagnosis of the malignant disease (р = 0.002, RR 26.6% in malignant and only 8.1% in nonmalignant pathology), central nervous system irradiation prior to HSCT (p = 0.002, RR 32.6% with cranial irradiation compared to 15.6% without it), female gender (р = 0.003, RR increases up to 3 times – 26.9% in girls against 9.3% in boys). We also describe cases of the fertility restoration and birthgiving. The algorithm of diagnostic and follow-up of gonadal pathology in children after allo-HSCT is shown.

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The authors declare that there are no conflicts of interest present.