ESPE Abstracts (2021) 94 P1-144

ESPE2021 ePoster Category 1 Sex Endocrinology and Gonads B (10 abstracts)

Ovarian AMH production is transiently affected in pubertal and prepubertal girls with acute lymphoblastic leukaemia and non-Hodgkin lymphoma receiving chemotherapy: a prospective, longitudinal study.

Jimena C. Lopez Dacal 1 , Silvina Prada 2 , Marcela E. Gutiérrez 2 , Patricia Bedecarrás 1 , M. Gabriela Ropelato 1 , Andrea Arcari 1 , M. Gabriela Ballerini 1 , Mirta Gryngarten 1 , Marcela Soria 2 , Lorena Morán 2 , Cristina Ferraro 2 , Analía Freire 1 , Ignacio Bergadá 1 , Guillermo Drelichman 2 , Luis Aversa 2 , Rodolfo A. Rey 1 & Romina P. Grinspon 1

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1Centro de Investigaciones Endocrinológicas, "Dr. César Bergadá", (CEDIE) CONICET-FEI, División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina; 2Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina


Introduction: Improvements in the treatment of acute lymphoblastic leukaemia (ALL) and non-Hodgkin lymphoma (NHL) have increased survival, with the consequent concern about the long-term effects that childhood chemotherapy may have on ovarian function. AMH constitutes an indirect, reliable biomarker of the ovarian reserve, useful for the assessment of cancer therapy-related ovarian damage.

Aim: To evaluate small ovarian follicle status in girls and adolescents with hematologic malignancies during and after treatment (Post Tx).

Methods: prospective cohort study in children with ALL or NHL. Serum AMH was measured (EIA Inmunotech-Beckmann-Coulter) at diagnosis, during chemotherapy and until 3 year after treatment completion. Secondarily, FSH levels were analysed. Results were interpreted according to age or pubertal stage as appropriate and expressed as median (range).

Results: Twenty-three girls aged 7,3 yr (1-15,7) were included; 15 were prepubertal and 8 were pubertal at diagnosis. NHL was diagnosed in 4 (17,4%) and ALL in 19 (82,6%), of which 6/19 (31,6%) were high risk and 13 (68,4%), intermediate or standard risk. Total follow-up was 4,7 yr (3-5,1). AMH was low (<3rd centile) in 20 patients (86.9%) at some point during treatment. In 4 girls AMH was low since diagnosis. In the others, a marked decrease in AMH was observed between 6 and 12 months of treatment. Fifteen out of 20 (75%) patients recovered normal serum AMH. (Table); 4 of the 5 girls who did not recover AMH had basal AMH <25th centile and a diagnosis of high-risk ALL or NHL, receiving more aggressive chemotherapy. A mild and transient increased FSH was seen in 12 (52,1%), 7 prepubertal and 5 pubertal, All girls who received pubertal inhibition treatment recovered their sexual cycles within 7 months of suspension.

AMH Basal 3m 6m 9m 12m 15m 18m 24m 12m Post Tx 24m Post Tx 36m Post Tx
pmol/l 13.0 (1.2-55) 6.7 (1.2-38) 1.9 (1.2-21) 5.1 (1.2-25.6) 4.8 (1.2-49) 9.0 (1.2-71.2) 14.7 (1.2-40.5) 15.2 (3-29.7) 17.7 (3-58.4) 14.9 (1.2-46.2) 17.6 (1.2-41.7
< 3rd Pc n (%) 4 (17.4) 8 (34.8) 14 (63.3) 12 (60.0) 10 (50.0) 5 (26.3) 5 (27.7) 2 (10.5) 3 (13.0) 3 (13.0) 5 (21.7)

Conclusion: These preliminary results suggest that most girls with ALL or NHL suffered a transient impairment of the small ovarian follicle pool during chemotherapy, with recovery in a large majority of them in the long-term. Most of the girls with persistently low AMH had received more aggressive chemotherapy.

Volume 94

59th Annual ESPE (ESPE 2021 Online)

Online,
22 Sep 2021 - 26 Sep 2021

European Society for Paediatric Endocrinology 

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