melphalan and Infertility--Female

To investigate a possible difference between true ovarian volume and ovarian volume estimated with two-dimensional (2D) transvaginal ultrasound.. Prospective clinical and laboratory study.. University hospital research laboratory.. Premenopausal girls and women from three Danish national fertility centers (A: n = 42; B: n = 6; C: n = 18), who had one entire ovary removed for cryopreservation of ovarian cortex.. Transvaginal 2D ultrasound measurement of ovarian volume before oophorectomy. True ovarian volume was obtained by weighing the ovary.. Ovarian volume estimated by weight and ultrasound.. Ovarian tissue density was 1.00 g/mL. Mean ovarian volume by ultrasound vs. weight in the three groups was as follows: A: 6.3 mL vs. 7.8 mL; B: 5.4 mL vs. 6.8 mL; and C: 2.8 mL vs. 6.1 ml. Ovarian volume obtained by ultrasound was at least 27% smaller than the true ovarian volume.. Ovarian volume was severely underestimated by transvaginal 2D ultrasound measurement.

Topics: Adult; Anti-Mullerian Hormone; Female; Humans; Immunoglobulin G; Infertility, Female; Melphalan; Menstrual Cycle; Neoplasms; Oocytes; Ovariectomy; Ovary; Prospective Studies; Ultrasonography; Vagina

Melphalan has rarely been used as a single agent for conditioning prior to allogeneic marrow transplantation. Twenty-eight patients (median age 19.5 years) undergoing allogeneic BMT for acute leukemia (n = 26) or lymphoblastic lymphoma (n = 2) in first remission (n = 10) or beyond (n = 18) from HLA-identical siblings received 240 mg/m2 melphalan. Death due to primary graft failure was seen in two patients. Sustained hematopoietic recovery was seen in all the others (n = 22) not dying early due to toxicity (n = 2) or persistent active disease (n = 2). The 3-year probabilities of transplant-related mortality and relapse were 35% and 62%, respectively. Seven patients are alive and well at 103-163 months (median 136) with Karnofsky scores of 100% (10-year disease-free survival, 25%). Of the 16 patients with donors of the opposite sex, seven underwent cytogenetic studies after BMT and showed complete chimerism with donor cells. Amongst the four women who were 15-30 years at the time of the transplant, there were seven pregnancies over 297 months of follow-up beyond 2 years from transplant. In contrast, no pregnancies were seen in 53 women with hematologic malignancies who were conditioned with other regimens over 3524 months of follow-up beyond 2 years from transplant. The pregnancy rate was significantly higher (P < 0.001) for women conditioned with melphalan alone (three of four) than for those conditioned with other regimens (0 of 53). We conclude that pre-transplant conditioning with melphalan alone permits alloengraftment of marrow from HLA-identical siblings, and may preserve fertility better than other regimens in some women.

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Child, Preschool; Cyclophosphamide; Disease-Free Survival; Female; Graft vs Host Disease; Hematologic Neoplasms; Histocompatibility; Humans; Infertility, Female; Male; Melphalan; Nuclear Family; Pregnancy; Pregnancy Rate; Retrospective Studies; Salvage Therapy; Tissue Donors; Transplantation Conditioning; Treatment Outcome; Whole-Body Irradiation