Gynecological aspects of the management of children with malignant blood diseases and similar conditions


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Abstract

Background. Thanks to the current advances in hematologic oncology, the healthcare system faces a task of preserving the reproductive potential in surviving patients. The high efficiency of specific treatment for malignant blood diseases (MBD) and similar conditions is associated with high risks for reproductive disorders. Pediatric and adolescent patients occupy a special place. In 2017, the number of children with any cancer was 88.1 per 100,000 people in the Russian Federation. At the same time, global statistics show that in girls aged 0 to 14 years, acute leukemias account for up to 40% of cancers, which is 2.6 times higher than those in women aged 15-44 years. Case report. The paper deals with the pattern and features of gynecological diseases characteristic for girls with MBD and similar conditions. Information is provided on the degree of gonadotoxicity of different classes of chemotherapy drugs, the procedures of gonadal shielding, and an individual approach to preventing uterine bleeding, as well as indications for and options of hormonal correction of estrogen deficiency. The paper presents a clinical case of a complication of medication-induced menses suppression in a 16-year-old patient, describes a case of extramedullary (ovarian) leukemic relapse in a 12-year-old girl, and gives an example of management of a 17-year-old patient with genital manifestations of grade III graft-versus-host disease. It considers the features of genital inflammatory diseases in girls with MBD: the high incidence of the torpid course of purulent vulvovaginitis; isolation of bacteria resistant to most antibiotics; the susceptibility of these patients to soft tissue infections; a prolonged course of vulvovaginal candida infection. The paper provides an example of vulvar lesion in a 3.5-year-old child with Langerhans cell histiocytosis. Conclusion. The literature data and the authors’ own observations contained in the article provide an opportunity to get an idea of the peculiarities of a gynecologist’s work with this specific group of patients as children with MBD and similar conditions.

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About the authors

Nadezhda A. Kokhreidze

V.A. Almazov National Medical Research Center, Ministry of Health of Russia

Email: kokhreidze_na@almazovcentre.ru
Dr. Med. Sci., Associate Professor, Head of the Department of Gynecology of Children and Adolescents, Children's Medical and Rehabilitation Complex

Kyaniz Kh. Alieva

V.A. Almazov National Medical Research Center, Ministry of Health of Russia; R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology, and Transplantology Clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: alieva_kkh@almazovcentre.ru
obstetrician-gynecologist, Department of Gynecology of Children and Adolescents, Children's Medical and Rehabilitation Complex

Elena A. Ulrikh

V.A. Almazov National Medical Research Center, Ministry of Health of Russia

Email: ulrikh_ea@almazovcentre.ru
Dr. Med. Sci., Professor, oncologist-gynecologist

Kirill A. Ekushev

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology, and Transplantology Clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: ekushov.kirill@mail.ru
oncohematologist

Olesya V. Paina

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology, and Transplantology Clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

PhD, Head of the Department of Bone Marrow Transplantation for Children No. 1

Lyudmila S. Zubarovskaya

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology, and Transplantology Clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: zubarovskaya_ls@mail.ru
Dr. Med. Sci., Professor, Head of the Department of Oncology, Hematology and Transplantology for Children

Olesya A. Efimova-Korzeneva

R.M. Gorbacheva Research Institute of Pediatric Oncology, Hematology, and Transplantology Clinic, Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia

Email: lesyakorzeneva@yandex.ru
obstetrician-gynecologist

References

  1. Диникина Ю.В., Белогурова М.Б., Говоров И.Е., Гамзатова З.Х., Первунина Т.М., Комличенко Э.В. Криоконсервация ткани яичника у девочек с онкологической патологией: мультидисциплинарная программа. Российский журнал детской гематологии и онкологии 2019; 6(3): 59-67. [Dinikina Yu.V., Belogurova M.B., Govorov I.E., Gamzatova Z.H., Pervunina T.M., Komlichenko E.V. Cryopreservation of ovarian tissue in girls with cancer: a multidicsciplinary approach. Russian journal of pediatric hematology and oncology. 2019; 6(3): 59-67 (in Russian)].
  2. Каприн А.Д., Старинский В.В., Петрова Г.В., ред. Состояние онкологической помощи населению России в 2017 году. М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России; 2018. 236с. [Kaprin A.D., Starinskiy V.V., Petrova G.V., eds. The status of cancer care for the population of Russia in 2017. A.D. Kaprin, V.V. Starinskiy, G.V. Petrova (eds.). M.: P.A. Hertzen Moscow Oncology Research Institute - branch of the National Medical Research Center of Radiology, Ministry of Health of Russia, 2018. 236 p. (in Russian)].
  3. Baade P.D., Youlden D.R., Valery P.C., Hassall T., Ward L., Green A.C., Aitken J.F. Childhood cancer incidence in Australia, 1983-2006. Br. J. Cancer. 2010; 102(3): 620-6. https://dx.doi.org/10.1038/sj.bjc.6605503.
  4. Landis S.H., Murray T., Bolden S., Wingo P.A. Cancer statistics, 1999. CA Cancer J. Clin. 1999; 49(1): 8-31. https://dx.doi.org/10.3322/canjclin.49.1.8.
  5. Gerstl B., Sullivan E., Koch J., Wand H., Ives A., Mitchell R. et al. Reproductive outcomes following a stem cell transplant for a haematological malignancy in female cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2019; 27(12): 4451-60. https://dx.doi.org/10.1007/s00520-019-05020-8.
  6. de Bree E., Makrigiannakis A., Askoxylakis J., Melissas J., Tsiftsis D.D. Pregnancy after breast cancer. A comprehensive review. J. Surg. Oncol. 2010; 101(6): 534-42.
  7. Azim H.A. Jr., Santoro L., Pavlidis N., Gelber S., Kroman N., Azim H., Peccatori F.A. Safety of pregnancy following breast cancer diagnosis: a metaanalysis of 14 studies. Eur. J. Cancer. 2011; 47(1): 74-83.
  8. ACOG Committee Opinion No. 747: Gynecologic issues in children and adolescent cancer patients and survivors. Obstet. Gynecol. 2018; 132(2): e67-77. https://dx.doi.org/10.1097/AOG.0000000000002764.
  9. Close A.G., Jones K.A., Landowski A., Switzer G.E., Kazmerski T.M., Miller E., Friehling E. Current practices in menstrual management in adolescents with cancer: A national survey of pediatric oncology providers. Pediatr. Blood Cancer. 2019; 66(12): e27961. https://dx.doi.org/10.1002/ pbc.27961.
  10. Adegite E.A., Goyal R.K., Murray P.J., Marshal M., Sucato G.S. The management of menstrual suppression and uterine bleeding: a survey of current practices in the Pediatric Blood and Marrow Transplant Consortium. Pediatr. Blood Cancer. 2012; 59(3): 553-7. https://dx.doi.org/10.1002/pbc.23360.
  11. LorenA.W, ManguP.B., BeckL.N., BrennanL., MagdalinskiA.J., PartridgeA.H. et al.; American Society of Clinical Oncology. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J. Clin. Oncol. 2013; 31(19): 2500-10.
  12. Hyman J.H., Tulandi T. Fertility preservation options after gonadotoxic chemotherapy. Clin. Med. Insights Reprod Health. 2013; 7: 61-9.
  13. Папуша Л.И., Балашов Д.Н., Тюльпаков А.Н., Скоробогатова Е.В., Курникова Е.Е., Скворцова Ю.В., Масчан А.А. Половое развитие и функция гонад у детей и подростков после аллогенной трансплантации гемопоэти-ческих стволовых клеток с использованием различных режимов кондиционирования. Онкогематология. 2009; 4(2): 61-9. [Papusha L.I., Balashov D.N., Tul’pakov A.N., Skorobogatova E.V., Kurnikova E.E., Skvortsova Yu.V., Maschan A.A. Sexual development and gonad function in children and adolescents after allogeneic hematopoietic stem cell transplantation using various modes. Oncogematology. 2009; 4(2): 61-9. (in Russian)].
  14. Кулева С.А., Курочкина Д.Н., Звягинцева Д.А., Иванова С.В., Цырлина Е.В. Онкофертильность у женщин, излеченных в детстве от лим-фомы Ходжкина. Медицинский совет. 2019; 6: 176-83. https://doi.org/10.21518/2079-701X-2019-6-176-183.
  15. Meirow D., Rabinovici J., Katz D., Or R., Shufaro Y., Ben-Yehuda D. Prevention of severe menorrhagia in oncology patients with treatment induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer. 2006; 107(7): 1634-41.
  16. Kirkham Y.A., Ornstein M.P, Aggarwal A., McQuillan S. No. 313-menstrual suppression in special circumstances. J. Obstet. Gynaecol. Can. 2019; 41(2): e7-e17. https://dx.doi.org/10.1016/j.jogc.2018.11.030.
  17. American College of Obstetricians and Gynecologists. Options for prevention and management of heavy menstrual bleeding in adolescent patients undergoing cancer treatment. ACOG Committee Opinion No. 606. Obstet. Gynecol. 2014; 124(2): 397-402.
  18. Белогурова М.Б., Диникина Ю.В., Лисянская А. С., Тапильская Н.И., Радулеску Г.Г., Викторович Т.Д., Шац Л.И., Чавпецова Э.Д. Возможности применения аналогов гонадотропин-рилизинг гормона у девочек пубертатного возраста с онкологическими заболеваниями. Российский журнал детской гематологии и онкологии. 2015; 4(2): 34-41. [Belogurova M.B., Dinikina Yu.V., Lisyanskaya A.S., Tapil'skaya N.I., Radulesku G.G., Viktorovich T.D., Shac L.I., Chavpecova E.D. Eurasian Oncology JournalPossibilities of using analogues of gonadotropin-releasing hormone in puberty girls with cancer. Russian Journal of Pediatric Hematology and Oncology. 2015; 4(2): 34-41. (in Russian)]. https://dx.doi.org/10.17650/2311-1267-2015-2-4-34-41.
  19. Clinical Practice Guidelines. Chairman, Franklin O Smith, MD. Pediatric Blood & Marrow Transplant Consortium. September 2002.
  20. Cagnacci A, Ramirez I., Bitzer J., Gompel A. Contraception in cancer survivors - an expert review Part II. Skin, gastrointestinal, haematological and endocrine cancers. Eur. J. Contracept. Reprod. Health Care. 2019; 24(4): 299-304. https:// dx.doi.org/10.1080/13625187.2019.1604947.
  21. Wo J.Y., Viswanathan A.N. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int. J. Radiat. Oncol. Biol. Phys. 2009; 73(5): 1304-12.
  22. Радулеску Г.Г., Матченкова Н.В., Белогурова М.Б. Эндокринологические осложнения у пациентов, получивших противоопухолевую терапию в детском возрасте. Педиатр. 2016; 1(7): 120-8. [Radulesku G.G., Matchenkova N.V., Belogurova M.B. Endocrinological complications in patients receiving anticancer therapy in childhood. Pediatr. 2016; 1(7): 120-8. (in Russian)]. https://dx.doi.org/1010.17816/PED71120-128.
  23. Pentheroudakis G., Orecchia R., Hoekstra H.J., Pavlidis N.; ESMO Guidelines Working Group. Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2010; 21(Suppl. 5): v266-73. https://dx.doi.org/10.1093/annonc/mdq198.
  24. Gui W., Li J., Zhang Z., Wang L., Zhao J., Ma L., Su L. Primary hematological malignancy of the uterine cervix: A case report. Oncol. Lett. 2019; 18(3): 3337 41. https://dx.doi.org/10.3892/ol.2019.10652
  25. Imanaka R., Katayama Y., Iwato K., Kyo K., Okatani T., Itagaki M. et al. Acute leukemia recurring as extramedullary tumors of the ovary following allogeneic hematopoietic stem cell transplantation]. Rinsho Ketsueki. 2018; 59(1): 58-63. https://dx.doi.org/10.11406/rinketsu.59.58.
  26. Kim J.W., Cho M.K., Kim C.H., Kim K.M., Cho M.K., Kim S.M. et al. Ovarian and multiple lymph nodes recurrence of acute lymphoblastic leukemia: a case report and review of literature. Pediatr. Surg. Int. 2008; 24(11): 1269-73. https:// dx.doi.org/10.1007/s00383-008-2253-2.
  27. Ciavattini A., Clemente N. Female genital tract chronic graft-versus-host disease: review of the literature. Anticancer Res. 2015; 35(1): 13-7.
  28. Rajkumar S., Lewis F., Nath R. The importance of topical steroids after adhesiolysis in erosive lichen planus and graft versus host disease. J. Obstet. Gynaecol. 2019; 39(1): 82-5. https://dx.doi.org/10.1080/01443615.2018.1463207.
  29. Hirsch P., Leclerc M., Rybojad M., Petropoulou A.D., Robin M., Ribaud P. et al. Female genital chronic graft-versus-host disease: importance of early diagnosis to avoid severe complications. Transplantation. 2012; 93(12): 1265-9.
  30. Stratton P., Turner M.L., Childs R., Barrett J., Bishop M., Wayne A., Pavletic S. Vulvovaginal chronic graft-versus-host disease with allogeneic hematopoietic stem cell transplantation. Obstet. Gynecol. 2007; 110(5): 1041-9.
  31. Machado A.M.N., Hamerschlak N., Rodrigues M., Piccinato C.A., Podgaec S., Mauad L.M.Q. Female genital tract chronic graft-versus-host disease: A narrative review. Hematol. Transfus. Cell Ther. 2019; 41(1): 69-75. https:// dx.doi.org/10.1016/j.htct.2018.06.005.
  32. Fule Robles J.D., Cheuk D.K., Ha S.Y., Chiang A.K., Chan G.C. Human herpesvirus types 6 and 7 infection in pediatric hematopoietic stem cell transplant recipients. Ann. Transplant. 2014; 19: 269-76. https://dx.doi. org/10.12659/AOT.889995.
  33. Hilal T., Gea-Banacloche J.C., Leis J.F. Chronic lymphocytic leukemia and infection risk in the era of targeted therapies: Linking mechanisms with infections. Blood Rev. 2018; 32(5): 387-99. https://dx.doi.org/10.1016/j. blre.2018.03.004.
  34. Короткий Н.Г., Андреенко О.А., Вяльцева Ю.Ю., Нажимов В.П. Гистиоцитоз Х (клинический случай). Детская больница. 2012; 3: 65-8. [Korotkiy N.G, Andreenko O.A., Vyaltseva Yu.Yu., Nazhimov V.P. Histiocytosis X (clinical case). Children's Hospital. 2012; 3: 65-8. (in Russian)].

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