Investigation on the Occurrence of Premature Ovarian Insufficiency after Allogeneic Haematopoietic Stem Cell Transplantation and Prognosis Analysis - a single-center real-world cross-sectional study

Introduction : Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for patients with hematologic disorders; however, the pre-HSCT conditioning regimen may induce premature ovarian insufficiency (POI)—characterized by menstrual disorders and infertility—which significantly compromises female patients’ quality of life. This real-world cross-sectional study aimed to identify risk factors for POI by analyzing menstrual flow status, fertility changes, and determinants of perimenopausal symptoms in female patients following allogeneic HSCT. Methods Fifty-four female patients who underwent allogeneic HSCT at the Affiliated Hospital of Qingdao University from April 2012 to November 2023 were enrolled. Assessments including peripheral blood sex hormone level analysis and questionnaires were used to evaluate menstrual flow status, fertility changes, and determinants of perimenopausal symptoms. Risk factor analysis was primarily performed via binary logistic regression, columnar line chart models and receiver operating characteristic (ROC) curves. Results A total of 43 patients (78.18%) developed secondary POI after allogeneic HSCT, with a median age of 29 years (range: 5–39 years). Among the enrolled patients, 10 received the fludarabine + cyclophosphamide + antithymocyte globulin conditioning regimen, and 44 received busulfan (Bu)-based regimens. Binary logistic regression analysis revealed that older age (> 10 years) at transplantation and Bu-based conditioning regimens were risk factors for POI development post- allogeneic HSCT. Conclusion POI is common in female patients after allogeneic HSCT. Older age at transplantation and the use of busulfan (Bu)-based conditioning regimens may be key risk factors for post- allogeneic HSCT POI.