Indian Journal of Hematology and Blood Transfusion | 2019
Spontaneus Triplet Birth After Acute Lymphoblastic Leukemia Treatment
Abstract
Chemotherapy protocols have allowed appreciable survival of childhood acute lymphoblastic leukemias (ALL) and enabled women survivors to bear children [1]. Alkylating agents, total body irradiation, and lower abdominal/pelvic radiotherapy in particular, may adversely affect reproductive function, resulting in subor infertility and a premature menopause. In a nationwide retrospective cohort study on female fertility in Dutch, 70% of female childhood cancer survivors reported a female factor as cause of subfertility compared to 34% of health controls, and seemed more likely to use fertility treatment [1]. Moreover, infertility rate is lower in the girls who have undergone 18–24 Grays cranial prophylactic radiotherapy than without radiotherapy [2]. It is possible that radiation-induced changes to the hypothalamus might interfere with the normal gonadotropin releasing hormone ‘‘pulse-generator’’ for normal ovulation. Spontaneous triplet pregnancy occurs in about 0.015% of gestations [3]. Previously, spontaneous triplet pregnancy has not been reported in a female treated with leukemia in childhood. Herein, we report a female diagnosed with ALL who became spontaneous triplet pregnant after high dose chemotherapy and radiotherapy. A 16-year-old female was diagnosed as T cell ALL at 2003. Her menarche had been began at 12 years of age. She received the St. Jude Total XIII High-risk protocol. At this protocol, to prevent central nerve system recurrence, the high-risk protocol recommends prophylactic craniospinal irradiation. She received prophylactic craniospinal irradiation of 24 Gy in 12 fractions. She married 6 months prior to the completion of her maintenance therapy at the age of 19. Her first pregnancy resulted in miscarriage in the third month of gestation. Firstly, at 21 years of age, she naturally delivered a baby girl weighing 3500 g at 39 weeks gestation. Secondly, at 25 years of age, she delivered a baby boy weighing 3350 g at 38 weeks with cesarean section. Thirdly, at 28 years of age, she became triplet pregnant spontaneously and delivered three babies weighing 1380 g (boy), 1770 g (girl), 1780 g (girl) at 32 weeks and 2 days gestation with cesarean section with no abnormalities. The mother and all five babies have been well ever since, with no apparent abnormalities nor complications. The patient remained in remission. Now, she is 32-years old and healthy and have five healthy children. Our patient was diagnosed with leukemia after menarche in the adolescent period. She received a high-risk chemotherapy protocol and received high dose 24 Gy craniospinal radiotherapy. These are all risk factors for infertility. Despite this, the fertility of our patient is not impaired. Multiple pregnancies such as triplets are seen mostly after in vitro fertilization. Studies on the fertility status of female patients with leukemia therapy have been needed. As the success of leukemia treatment increases, it is important for the survived patients to have a social job, to have marriage and to have children. It is hopeful that patients receiving radiotherapy and intensive chemotherapy will still have the chance to have children despite everything. Nowadays, we advise ovarian & Canan Albayrak [email protected]