ESPE Abstracts

Background: Most reports on gonadotoxicity associated with chemotherapy of acute lymphoblastic leukemia (ALL) comes from studies in adults, and they are mainly focused on the sensitivity of testicular germ cells. Little attention has been placed on Sertoli cells in prepubertal patients, even though Sertoli cell function is essential for adult spermatogenesis.

Objective: To evaluate Sertoli cell function in prepubertal boys who receive chemotherapy for ALL.

Materials and methods: A prospective study including prepubertal male patients with ALL. Main outcome measure was serum AMH level after each phase of chemotherapy and 1 year after treatment completion. Secondarily, FSH levels were measured. Results are expressed as medians (range).

Results: Twenty-six boys with ALL were included: 24 had LLAB and 2 LLAT (four standard, 14 medium and eight high-risk ALL), age at diagnosis was 4.2 year (0.4–14.3). Serum AMH was: at diagnosis, 605 pmol/l (152–1333); at the end of induction (n=19), 833 (170–1697)=143% of pre-treatment level (92–274); after intensification (n: 23), 742 (240–1660)=138% (58–251); after Phase 1 (n=14), 644 (265–1095)=112% (53–150); prior to start of maintenance (n=16), 674 (351–1300)=109% (67–199); at 6 months of maintenance (n=11), 695 (312–1386)=104% (63–215); at the end of treatment (n=7), 817 (523–1563)=131% (87–291); and 3 months after the end of treatment (n=5), 738 (396–1336)=107% (75–123) of pre-treatment AMH level. Serum AMH decreased below 70% of pre-treatment level during chemotherapy in six of eight patients with high risk ALL, in 1 of 14 with medium risk and in none with standard risk. Only six patients (23%) had a transient mild FSH elevation.

Conclusion: These preliminary results showed that Sertoli cell function is not affected by chemotherapy in prepubertal boys with standard or medium risk ALL, but is at least transiently affected in those with high risk LLA.