异基因造血细胞移植（alloHCT）后长期生存率的提高使得年轻成年癌症幸存者的计划生育成为一个重要话题。然而，与治疗相关的不孕风险带来了挑战。为了评估当代队列的妊娠和出生率，我们利用德国移植登记处的数据进行了一项全国多中心研究，重点关注 2003 年至 2018 年间接受 alloHCT 的 18-40 岁成年女性。在 2,654 名接受移植的女性中，有 50 名女性经历了异体 HCT。 74 例妊娠，平均发生在移植后 4.7 年。其中 57 例实现了活产（77%）。 HCT 接受者的年第一胎出生率为 0.45%（95%CI：0.31 - 0.59%），比一般人群低六倍多。 HCT 10 年后活产的概率为 3.4%（95%CI：2.3-4.5%）。与怀孕可能性增加相关的因素包括进行 alloHCT 时年龄较小、非恶性移植指征、未接受全身照射 (TBI) 或累积剂量 <8 Gray，以及非清髓/降低强度预处理。 72% 的怀孕是自然怀孕，其余情况则使用辅助生殖技术 (ART)。早产和低出生体重比一般人群更为常见。这项研究代表了报告成年女性 alloHCT 接受者群体怀孕情况的最大数据集。我们的研究结果强调了 alloHCT 接受者怀孕的可能性很大。 ART 技术很重要，应该提供资金。然而，不应低估自然怀孕的可能性，并且应告知患者尽管生育能力下降，但意外怀孕的可能性。需要进一步的研究来了解调理决策对保留生育能力的影响。版权所有 © 2024 美国血液学会。

Improved long-term survival rates after allogeneic hematopoietic cell transplantation (alloHCT) make family planning for young adult cancer survivors an important topic. However, treatment-related infertility risk poses challenges. To assess pregnancy and birth rates in a contemporary cohort, we conducted a national multicenter study using data from the German Transplant Registry, focusing on adult women aged 18-40 who underwent alloHCT between 2003 and 2018. Out of 2,654 transplanted women, 50 women experienced 74 pregnancies, occurring at a median of 4.7 years post-transplant. Fifty-seven of these resulted in live births (77%). The annual first birth rate among HCT recipients was 0.45% (95%CI: 0.31 - 0.59%), which is more than six times lower than in the general population. The probability of a live birth 10 years after HCT was 3.4 % (95%CI: 2.3- 4.5%). Factors associated with an increased likelihood of pregnancy were younger age at alloHCT, non-malignant transplant indications, no total-body-irradiation (TBI) or a cumulative dose of <8 Gray, and non-myeloablative/reduced-intensity conditioning. 72% of pregnancies occurred spontaneously, with assisted reproductive technologies (ART) used in the remaining cases. Preterm delivery and low birth weight were more common than in the general population. This study represents the largest dataset reporting pregnancies in a cohort of adult female alloHCT recipients. Our findings underscore a meaningful chance of pregnancy in alloHCT recipients. ART techniques are important and funding should be made available. However, the potential for spontaneous pregnancies should not be underestimated, and patients should be informed of the possibility of unexpected pregnancy despite reduced fertility. Further research is warranted to understand the impact of conditioning decisions on fertility preservation.Copyright © 2024 American Society of Hematology.