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Gonadal and uterine function in female survivors treated by chemotherapy, radiotherapy, and/or bone marrow transplantation for childhood malignant and non‐malignant diseases
Author(s) -
Beneventi F,
Locatelli E,
Giorgiani G,
Zecca M,
Locatelli F,
Cavagnoli C,
Simonetta M,
Bariselli S,
Negri B,
Spinillo A
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12715
Subject(s) - medicine , cohort , total body irradiation , radiation therapy , chemotherapy , interquartile range , transplantation , population , oncology , regimen , gastroenterology , urology , gynecology , cyclophosphamide , environmental health
Objective To evaluate gonadal function and uterine volume in a cohort of female survivors treated by chemotherapy, radiotherapy, and/or stem cell transplantation ( SCT ) for childhood malignant and non‐malignant diseases. Design An observational study. Setting S. Matteo Hospital, Pavia, Italy. Population A cohort of 135 female survivors. Methods A clinical, hormonal, and ultrasonographic evaluation. Thirty‐three patients (24%) had non‐malignant haematologic diseases (thalassaemia or sickle cell anaemia), 68 (50%) had leukaemia, 23 (17%) had lymphomas, and 11 (8%) had solid tumours. In total, 106 patients had received SCT , preceded by a conditioning regimen. Main outcome measures Anti‐M ü llerian hormone ( AMH ) and Inhibin–B, and uterine volume. Results The median concentrations of AMH and Inhibin–B in the entire cohort were 0.12 ng/ml (interquartile range, IQR , 0.1–0.5 ng/ml) and 3.5 pg/ml ( IQR 0.1–13.2 pg/ml), respectively. In a stepwise ordered logistic regression analysis, conventional chemotherapy for the treatment of malignancies, as opposed to total body irradiation ( TBI ), was the only oncologically significant predictor of increased AMH levels ( OR 4.8, 95% CI 1.9–12, P < 0.001). Conditioning treatment before or after menarche did not influence AMH concentrations ( P = 0.24). The best predictor of reduced uterine volume was TBI during the preparation for the allograft ( OR 3.5, 95% CI 1.4–8.4, P = 0.006). Increasing age at treatment ( OR 0.86, 95% CI 0.77–0.95, P = 0.04), chemotherapy, as opposed to other treatments ( OR 0.09, 95% CI 0.03–0.28, P < 0.001), and solid tumours as opposed to either leukaemia/lymphomas or non‐malignant diseases ( OR 0.2, 95% CI 0.07–0.56, P = 0.002) were associated with larger uterine volumes. Conclusions Conditioning therapies for SCT , including TBI , had the worst effects on uterine volume and gonadal reserve. Increasing age at treatment and conventional chemotherapy were associated with less detrimental effects on uterine volume.