Background: Gonadal dysfunction is one of the major endocrinological late effects among cancer survivors. Chemotherapeutic agents and radiation are so gonadotoxic that ovarian reserve diminishes. Measurement of anti-müllerian hormone (AMH) concentration is useful as a marker of ovarian reserve or gonadal deficiency in female childhood cancer survivors (CCSs), particularly among patients without high gonadotropin levels.
Objective and hypotheses: The aim of the study was to investigate the variations of serum AMH levels in determining the acute and chronic effects of cancer therapy on the ovarian reserve.
Method: We conducted a prospective, longitudinal study of AMH before and after different cancer therapy at a single hospital. The medical records of three included female patients with haematological disease were reviewed.
Results: <Case 1> Myelodysplastic syndrome, Therapy: 10 years 0 months~, reduced intensity stem cell transplantation (SCT), Preparation: Fludarabine 30 mg/m2 per day×5, L-PAM 90 mg/m2 per day×2, Puberty: thelarche 11y1m, menarche 12 years 5 months, AMH (ng/ml): 1.48 (pre), <0.10 (post SCT 19 m), 0.9 (12 m), 0.34 (15 m), <0.1 (1830 m). <Case 2> Acute lymphocytic leukaemia, Chemotherapy: 11 years 8 months~, Puberty: menarche 9 years, regular menstruation, AMH: 1.85 (pre), <0.10 (post 0 m), 1.46 (3 m), 0.60.7 (618 m), 1.24 (24 m). <Case 3> Acute myelocytic leukemia, Therapy: 13 years 11 months~ chemotherapy and myeloablative stem cell transplantation, Preparation: total body irradiation 2G years×6, L-PAM 90 mg/m2 per day×2, Puberty: menarche 12 years,post-treatment amenorrhea, AMH:1.41 (pre), 0.88 (during therapy), <0.10 (post SCT 0-24 m).
Conclusion: Different patterns of AMH during the recovery phase supported the significance of longitudinal study. AMH level after the treatments was low in patients with spontaneous puberty and with regular menstrual cycles, whereas gonadotropin were not increased. The time to measure AMH should not be just after the end of the therapy for the CCSs. This study may help to better understand the ovarian toxicity of cancer therapy and to predict the needs for hormone replacement therapy and fertility counselling in future.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology