Washington, DC (Press Release) - New research ties preparative procedures and com­pli­ca­tions as­so­ci­ated with blood or bone marrow trans­plan­ta­tion (stem cell trans­plan­ta­tion, SCT) with diminished sexual health in both men and women who have undergone the lifesaving procedure. Study data, published today in Blood, the Journal of the American Society of Hematology (ASH), con­firm chronic graft-versus-host disease (GVHD), a serious com­pli­ca­tion that occurs when donor cells attack the recipient’s cells, as a poten­tial source of sexual dysfunction and are the first to dem­onstrate an association between total body irradiation and sexual dysfunction in men. This study is one of the longest and is the most inclusive to date eval­u­ating sexual well-being in SCT survivors using rigorous, well-validated sexual function assess­ment tools.

SCT is an in­creas­ingly effective form of treat­ment for patients with blood cancer such as leukemia, lym­pho­ma, and myeloma. The procedure, which involves the trans­plan­ta­tion of cells taken either from a patient’s own blood or bone marrow (autologous trans­plan­ta­tion) or from a matched donor (allogeneic trans­plan­ta­tion), effectively “replaces” damaged cells with healthy cells. While SCT was once asso­ci­ated with high mortality, survival rates have steadily in­­creased, prompting research seeking to study and maxi­mize sur­vi­vors’ quality of life.

“Thanks to im­proved trans­plant survival rates, we have now been able to focus our efforts on examining how the procedure affects key aspects of recipients’ over­all quality of life, in­­clud­ing sexual health,” said lead study author F. Lennie Wong, PhD, of City of Hope in Duarte, California. “Previous findings point to the unfortunate fact that, while recipients may physically recover, their sexual health might not rebound as much or as quick­ly. Data have been limited to this point, prompting us to take a closer look at this issue in a larger, more di­verse group of au­tol­o­gous and allogeneic trans­plant survivors over an extended period.”

To further in­ves­ti­gate long-term effects of SCT on the sexual health of survivors, a team of researchers led by senior author Smita Bhatia, MD, MPH, surveyed 277 adult patients (152 men and 125 women; median age 48) who underwent SCT at City of Hope for blood cancer between February 2001 and January 2005 about their sexual activity. Participants com­pleted two questionnaires that together eval­u­ated specific areas of sexual function (sexual cognition/fantasy, sexual arousal, sexual behavior/experience, orgasm, and drive/​relationship) as well as sexual satisfaction at a median time of 17 days pre-transplant and at six, 12, 24, and 36 months post-transplant. A third questionnaire assessed over­all health-related quality of life.

Investigators’ analysis of questionnaire results (led by Dr. Wong) con­firmed pre­vi­ous studies in dem­onstrat­ing a definitive impact of SCT on survivors’ post-trans­plant sexual activity. During the three-year post-transplant analysis period, the per­cent­age of men who self-reported being “sexually active” (defined as having sex with a partner at least once in the preceding month) declined 7 per­cent­age points, with 61 per­cent of men reporting sexual activity pre-transplant and 54 per­cent reporting activity post-transplant. The opposite – a 15 per­cent­age point in­­crease in sexually active individuals – was observed in women, with 37 per­cent reporting sexual activity pre-transplant and 52 per­cent reporting activity post-transplant.

In addi­tion to further crystallizing trans­plan­ta­tion’s impact on survivors’ sexual health, study data specifically asso­ci­ated diminished sexual function and satisfaction with trans­plant-related total body radiation in men and chronic GVHD with diminished sexual function in men and both sexual function and satisfaction in women.

Investigators observed a nearly 18 per­cent decline in sexual function in men surveyed who had received total body radiation. The same group also reported an approx­i­mate 32 per­cent de­crease in sexual satisfaction, a 26 per­cent de­crease in sexual behavior/experience, a 26 per­cent de­crease in quality of orgasm, and 17 per­cent de­crease in sex drive/relationship since their trans­plant. Despite these effects in men, radiation had no such reported effect in women, an effect that investigators hypothesize may be explained by in­her­ent physiologic dif­fer­ences in the pathogenesis of sexual dysfunction among men and women.

In addi­tion to documenting concrete effects of radiation on sexual function and satisfaction, investigators also observed negative sexual effects among those surveyed who had ex­peri­enced chronic GVHD. Men surveyed who had developed the dangerous post-transplant com­pli­ca­tion reported a 21 per­cent de­crease in sexual cognition/fantasy and a 24 per­cent de­crease in the quality of orgasm since their trans­plant. Similarly, investigators observed a 27 per­cent decline in post-transplant sexual satisfaction among women surveyed who had ex­peri­enced chronic GVHD, with survey respondents also indicating a 27 per­cent decline in sexual arousal.

When compared to men, the women surveyed suffered sig­nif­i­cantly worse effects over­all, despite the fact that their sexual activity in­creased over the three-year survey period. Investigators concluded that this in­crease in activity may be explained by a corresponding im­prove­ment in female psychological quality of life post trans­plant.

From this research, investigators conclude that nearly half of SCT survivors are sexually inactive at three years post trans­plant and suggest that patients may benefit from speaking with their doctors about sex.

“It is not often that the trans­plant team and patient will have a conversation about how this procedure could impact their sex life, even after re­cov­ery; how­ever, we hope these findings will help encourage patients and their doctors to openly discuss concerns related to sexual dysfunction and address them with specialists who can help,” said Dr. Wong.

About Blood and the American Society of Hematology

Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field of hematology, is avail­able weekly in print and online. Blood is the official journal of the American Society of Hematology (ASH) (www.hematology.org), the world’s largest professional society concerned with the causes and treat­ment of blood disorders.

ASH’s mission is to further the under­stand­ing, diag­nosis, treat­ment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems by promoting research, clin­i­cal care, education, training, and advocacy in hematology.

blood® is a registered trademark of the American Society of Hematology.

Source: American Society of Hematology.