ESPE Abstracts

Objective: Endocrine disorders following acute lymphoblastic leukemia (ALL) treatment are notable in high-risk groups and those receiving high-dose chemotherapy due to bone marrow transplantation (BMT) or relapse. This study investigates endocrine effects after ALL treatment.

Methods: The study included cases diagnosed with ALL during childhood between 1995 and 2020, treated with the BFM-1995 protocol, and followed for at least 2 years. Anthropometric, biochemical, and hormonal measurements of all patients were taken in January-February 2023. Fertility was assessed using AMH in girls and AMH and spermiogram in boys. AMH levels below 1 ng/dL in girls and oligospermia/azoospermia/asthenozoospermia in boys were considered reproductive disorders. Risk classification (standard, intermediate, high) and treatment details (chemotherapy, radiotherapy, relapse, and BMT) were obtained from the files.

Results: The study included 101 patients (M:F = 50:51) with an average age of 16.3±6.1 years, diagnosis age 5.9 (0.6-17.1) years, and follow-up duration 10.4 (2.2-27.7) years. Fifteen patients received cranial radiotherapy, three had relapses, and six underwent BMT. During the follow-up, 50.5% had at least one endocrine disorder. All eight patients who received intensive chemotherapy due to relapse/BMT had reproductive disorders, and four (M:F=2:2) were found to have hypergonadotropic hypogonadism. Other patients had normal pubertal development, gonadotropin, and sex hormone levels. In girls who did not receive intensive chemotherapy due to relapse/BMT, 34,6% (n = 17) had AMH levels below 1 ng/dL. Linear regression analysis showed that while diagnosis age and risk group had no effect on AMH levels in girls, follow-up duration had a significant impact (β=0.470, P = 0.002); longer follow-up was associated with higher (normal) AMH levels, independent of diagnosis age and risk group. Among males who could provide a spermiogram and did not receive BMT treatment, 33.3% (6/18) had oligospermia/azoospermia/asthenozoospermia. The presence of an abnormal spermiogram in males was not associated with diagnosis age or follow-up duration but was related to chemotherapy intensity (Standard/Intermediate/High = 0%/53%/100%, P = 0.011). There was no significant difference in AMH levels between those with and without abnormal spermiogram findings (P = 0.482), and no significant correlation between AMH and sperm concentration was found.

Conclusion: Our findings suggest that AMH, gonadotropin, and sex hormones are insufficient for assessing reproductive function in males, and spermiogram evaluation is necessary in those capable of ejaculation. In females, the finding of higher AMH levels with increased follow-up time supports the literature that ovarian reserve can recover over time after chemotherapy.