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Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia
Author(s) -
Byrne Julianne,
Fears Thomas R.,
Mills James L.,
Zeltzer Lonnie K.,
Sklar Charles,
Nicholson H. Stacy,
Haupt Riccardo,
Reaman Gregory H.,
Meadows Anna T.,
Robison Leslie L.
Publication year - 2004
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.20033
Subject(s) - medicine , fertility , menarche , fertility preservation , psychosocial , radiation therapy , pediatrics , mood , late effect , cohort , gynecology , psychiatry , population , environmental health
Background Fertility impairments among women treated during childhood for cancer are known to occur after some, but not all, types of anticancer therapy. Although leukemia is the most common cancer of childhood, until now fertility in survivors has not been comprehensively assessed. Procedure We investigated functional impairment of fertility in women who were long‐term survivors of acute lymphoblastic leukemia (ALL) with a retrospective cohort study. Proven fertility (defined as ever pregnant) was evaluated by self‐report among 182 females treated on protocols of the Children's Cancer Group (age at interview, 22.6 years on average) and 170 controls drawn from among the survivors' female siblings (23.4 years). The interview included psychosocial inventories designed to detect mood problems. Results Significant fertility deficits were noted in female survivors treated with cranial radiotherapy (CRT) at any dose around the time of menarche (relative fertility (RF)) = 0.27, 95% CI = 0.09, 0.82, P = 0.03). Controlling for marital status, mood at interview, and many fertility‐related situations did not change the association. Conclusion This study provides evidence for fertility deficits after treatment for ALL with CRT, and, in addition, for the first time, suggests that girls treated around the time of menarche are especially at risk. Clinical confirmation of these results is needed. If gonadal damage occurs in women receiving these treatments, their risk for further sequelae, such as osteoporosis and heart disease, may be significantly raised, requiring active management and intervention. © 2004 Wiley‐Liss, Inc.