leuprolide and Hematologic-Neoplasms

The purpose of this study was to provide a systematic review on prevention and treatment of uterine bleeding in the setting of hematologic malignancy. We performed MEDLINE, PubMed, EMBASE and Cochrane searches with the terms uterine bleeding, uterine hemorrhage, hematologic malignancy. All identified literature sources were included in the review. The identified literature is largely comprised of case series and pilot studies. No evidence-based protocols for gynecologists and hematologists are available. The majority of the identified literature centers on menstrual suppression with GnRH agonists in hematologic malignancy, although no randomized trials could be identified. Review of the identified literature suggests that medical prevention with GnRH agonist therapy is highly effective for prevention of uterine bleeding in hematologic malignancy. With respect to treatment of acute uterine bleeding in the setting of hematologic malignancy, medical therapy can be used and is successful in the majority of patients, according to the identified studies. Surgical treatment should be used expeditiously if medical treatment options fail to control acute bleeding. Empiric prevention and treatment algorithms for the discussed clinical settings are proposed. More research is necessary on the topic, with the goal to develop evidence-based guidelines for gynecology and hematology-oncology care providers. Close cooperation between the specialties may improve morbidity and mortality associated with uterine bleeding in hematological malignancy in the future.

Topics: Antineoplastic Agents; Clinical Trials as Topic; Female; Hematologic Neoplasms; Humans; Leuprolide; Menstruation; Premenopause; Receptors, LHRH; Transplantation Conditioning; Uterine Hemorrhage

Prevention of uterine bleeding after stem cell transplantation was attempted in 30 consecutive premenopausal women affected by hematological malignancies. This was with luteinizing hormone-releasing hormone (LHRH) leuprorelin acetate depot 3.75 mg administered subcutaneously at least 30 days before the conditioning regimen and then 28 days after the first dose. Complete prevention resulted in all but one patient (96.5%) during the phase of profound thrombocytopenia. No side-effects related to leuprorelin were observed. All patients developed amenorrhea after transplantation. Gonadal function was periodically assessed by means of luteinizing hormone (LH), follicular stimulating hormone (FSH) and estradiol serum levels. Hormone levels were consistent with menopause in all patients. After transplantation, patients required hormone replacement with estroprogestinics or estrogens alone when indicated. Leuprorelin is highly effective in preventing uterine bleeding in premenopausal women undergoing stem cell transplantation and has an excellent toxicity profile and virtually no interface with hemostatic balance and hepatic function. The role of leuprorelin in gonadal protection is currently unclear and deserves further investigations.

Topics: Adolescent; Adult; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Leuprolide; Middle Aged; Uterine Hemorrhage