Introduction Hematopoietic stem cell transplantation (HSCT) has been recognized as a successful treatment for various malignant and nonmalignant blood disorders. The 5-year survival rate for children and adolescents diagnosed with leukemia has risen to over 90% in high-income countries. Nevertheless, it has been reported that between 65-84% of individuals who undergo HSCT suffer from ovarian failure, with only 0.6% managing to conceive successfully.

Methods To evaluate the fertility of young female survivors of blood diseases following allogeneic HSCT in China.102 pediatric and female patients aged 8-35 years who underwent HSCT between 1 January 2017 and 31 December 2018.

Results The incidence of POF was 88.2%(30/34), 93.9%(31/33) and 61.5%(8/13) for AML, ALL and AA young female patients following HSCT. Compared to the non-POF group, diagnosis of AA (p=0.028) had a lower incidence of POF with statistically significant difference. At the POF group, Cyclophosphamide equivalent dose (CED) was 10391 mg/m2(4890,10589) (p=0.222), and there was no significant difference. The incidence of POF was 74% in the group of patients under 13 years old and 94% in the group of patients ≥13 years old, with statistically significant difference (P=0.007). The usage rate of HRT was 63% in the group of <13 years old, while it reached 90% in the group of ≥13 years old.In multivariable analysis, only age at HSCT factor was independently associated with POF post HSCT.

Conclusion/Implications The incidence of POF in long-term young female survivors with hematological disease after HSCT was high and correlated significantly with age at HSCT.