ESPEYB17 9. Oncology and Chronic Disease Fertility-Related Issues (7 abstracts)
9.3. The influence of different intensity of treatment on hormonal markers of gonadal function in acute lymphoblastic leukemia survivors
Krawczuk-Rybak M , Płonowski M , Leszczyńska E , Latoch E , Sawicka-Żukowska M , Muszyńska-Rosłan K , Skalska-Sadowska J , Wachowiak J , Sga-Pondel D , Kazanowska B , Chybicka A , Stachowicz-Stencel T , Stefanowicz J , Malinowska I , Matysiak M , Kotan A , Wysocki M , Pobudejska-Piena¸żek A , Szczepański T , Przybyszewski B , Badowska W , Szymańska-Miller D , Kowalczyk JR , Kamieńska E , Urasiński T , Wawrzeńczyk A , Żelazowska-Rutkowska B & Cylwik B
To read the full abstract: Hematol Oncol. 2019 Dec;37(5):609–616. mar26@mp.pl
Acute lymphoblastic leukaemia (ALL) is the most common childhood neoplasia with an actual survival rate >80%. ALL treatment has changed considerably during last 30 years; radiotherapy with 24 Gy to the central nervous system (CNS) has been eliminated or reduced to lower doses (12 or 18 Gy) and chemotherapy regimens are now tailored to the specific disease risk. For these reasons, ALL survivors are usually considered to have a low risk of gonadotoxicity. In BFM (Berlin-Frankfurt-Munster) protocols, used in most European countries, patients are stratified into 3 risk groups: standard risk (SR), intermediate risk (IR), and high risk (HR), according to age at diagnosis, initial leucocyte count, immunophenotype of leukaemic blasts, their genetic abnormalities, and response to treatment. The total doses of chemotherapy and the use of cranial irradiation differ among the risk groups and so the impact of late toxicity can be different.
In the present study, sex hormone levels were analysed in 69 young ALL survivors stratified into SR, IR, and HR risk groups, and in 80 healthy controls of similar age. Compared to controls, HR group males showed higher levels of FSH and LH, lower inhibin B, and normal testosterone. Males in SR+IR groups showed hormonal values similar to controls. In females of all risk groups showed similar levels of FSH, LH, E2, and inhibin B to controls, however, mean AMH levels were slightly lower in SR+IR group females and significantly reduced in the HR group.
Semen analysis is the gold standard to assess male fertility, but it is often not feasible in young patients. FSH measurement is frequently used in clinical practice as a surrogate marker of spermatogenesis. Similarly, FSH measurement is used in females, as an index of ovarian reserve, despite its cyclic variability. Recently, inhibin B and AMH have been proposed as more reliable tools to assess gonadal function in CCS. Inhibin B, a glycoprotein hormone produced by Sertoli cells, plays an important role in the regulation of the hypothalamic-pituitary-gonadal axis and is an indirect marker of spermatogenesis. AMH is produced by granulosa cells and correlates with the number of mature follicles.
Due to the implementation and tailoring of therapy and supportive care, the burden of late effects observed in ALL survivors has changed, but some survivors still present significant sequelae. Testicular function can be affected by ALL itself, chemotherapy, administration of higher doses of gonadotoxic cytostatics, such as alkylating agents, radiation to the pelvic/gonadal area, cranial irradiation or total body irradiation. All of these factors can lead to poor sperm quality and/or oligospermia. In females, anticancer therapy can induce oocyte depletion. The present data indicate that even upgraded ALL treatment, usually considered less gonadotoxic, can cause gonadal dysfunction. ALL patients stratified into the HR group show signs of germ cell damage without overt hypogonadism. All of these patients should be informed about the possible late impact of ALL treatment on gonadal function and the need for lifelong follow up.
References:
1. Byrne J, Fears TR, Mills JL, et al. Fertility of long-term male survivors of acute lymphoblastic leukemia diagnosed during childhood. Pediatr Blood Cancer. 2004;42:364–72.
2. Wallace WHB, Anderson RA, Irvine DS. Fertility preservation for young patients with cancer: who is at risk and what can be offered? Lancet Oncol. 2005;6:209–18.
Article tools
My recent searches
My recently viewed abstracts
Authors
ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more