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.
22 Sep 2021 - 26 Sep 2021