Objective Female patients treated with alkylating agents in childhood are at risk for ovarian impairment. We aimed at describing the pattern of residual ovarian function in a cohort of survivors of hematological malignancies and/or hematopoietic stem cell transplantation (HSCT) and assessing the relationship between Cyclophosphamide Equivalent Dose (CED) and Anti-Müllerian Hormone (AMH). Design and methods Gonadal health was clinically and biochemically assessed in 124 post-menarchal survivors who underwent treatment for pediatric hematological malignancies and/or HSCT between 1992 and 2019. Results Overt "premature ovarian insufficiency" (POI) was detected in 72.1% and 3.7% of transplanted and non-transplanted patients, respectively; milder "diminished ovarian reserve" (DOR) in 16.3% and 22.2%. In non-transplanted patients, increasing CED values were associated with lower AMH-SDS (p 0.04), with the threshold of 7200 g/m2 being the best discriminator between DOR/POI and normal ovarian function (AUC: 0.75 on ROC analysis) and with an observed decrease of 0.14 AMH-SDS for each CED increase of 1 gr/m2. In addition, age at diagnosis ≥10 years played a detrimental role on ovarian reserve (p 0.003). In the HSCT group, irradiation was associated with a statistically significant reduction in AMH-SDS (p 0.04). Conclusions In non-transplanted patients, CED ≥ 7200 mg/m2 was associated with a DOR, while younger age at diagnosis played a protective role on ovarian reserve. As a result of the data collected, we propose a systematic algorithm to assess iatrogenic gonadal impairment in young female patients exposed to chemo-radiotherapy in childhood for hematological disorders.

Molinari, S., Parissone, F., Evasi, V., De Lorenzo, P., Valsecchi, M., Cesaro, S., et al. (2021). Serum anti-Müllerian hormone as a marker of ovarian reserve after cancer treatment and/or hematopoietic stem cell transplantation in childhood: proposal for a systematic approach to gonadal assessment. EUROPEAN JOURNAL OF ENDOCRINOLOGY, 185(5), 717-728 [10.1530/EJE-21-0351].

Serum anti-Müllerian hormone as a marker of ovarian reserve after cancer treatment and/or hematopoietic stem cell transplantation in childhood: proposal for a systematic approach to gonadal assessment

Molinari, Silvia
Primo
;
Evasi, Veronica;Valsecchi, Maria Grazia;Biondi, Andrea;Balduzzi, Adriana
Penultimo
;
Cattoni, Alessandro
Ultimo
2021

Abstract

Objective Female patients treated with alkylating agents in childhood are at risk for ovarian impairment. We aimed at describing the pattern of residual ovarian function in a cohort of survivors of hematological malignancies and/or hematopoietic stem cell transplantation (HSCT) and assessing the relationship between Cyclophosphamide Equivalent Dose (CED) and Anti-Müllerian Hormone (AMH). Design and methods Gonadal health was clinically and biochemically assessed in 124 post-menarchal survivors who underwent treatment for pediatric hematological malignancies and/or HSCT between 1992 and 2019. Results Overt "premature ovarian insufficiency" (POI) was detected in 72.1% and 3.7% of transplanted and non-transplanted patients, respectively; milder "diminished ovarian reserve" (DOR) in 16.3% and 22.2%. In non-transplanted patients, increasing CED values were associated with lower AMH-SDS (p 0.04), with the threshold of 7200 g/m2 being the best discriminator between DOR/POI and normal ovarian function (AUC: 0.75 on ROC analysis) and with an observed decrease of 0.14 AMH-SDS for each CED increase of 1 gr/m2. In addition, age at diagnosis ≥10 years played a detrimental role on ovarian reserve (p 0.003). In the HSCT group, irradiation was associated with a statistically significant reduction in AMH-SDS (p 0.04). Conclusions In non-transplanted patients, CED ≥ 7200 mg/m2 was associated with a DOR, while younger age at diagnosis played a protective role on ovarian reserve. As a result of the data collected, we propose a systematic algorithm to assess iatrogenic gonadal impairment in young female patients exposed to chemo-radiotherapy in childhood for hematological disorders.
Articolo in rivista - Articolo scientifico
fertility; anti-Müllerian hormone; premature ovarian insufficiency; alkylating agents; haematopoietic stem cell transplantation;
English
11-ott-2021
2021
185
5
717
728
none
Molinari, S., Parissone, F., Evasi, V., De Lorenzo, P., Valsecchi, M., Cesaro, S., et al. (2021). Serum anti-Müllerian hormone as a marker of ovarian reserve after cancer treatment and/or hematopoietic stem cell transplantation in childhood: proposal for a systematic approach to gonadal assessment. EUROPEAN JOURNAL OF ENDOCRINOLOGY, 185(5), 717-728 [10.1530/EJE-21-0351].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/327478
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