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Inhibin A Concentrations in the Sera of Young Women During and After Chemotherapy for Lymphoma: Correlation with Ovarian Toxicity
Author(s) -
Blumenfeld Z.,
Ritter M.,
ShenOrr Z.,
Shariki K.,
BenShahar M.,
Haim N.
Publication year - 1998
Publication title -
american journal of reproductive immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.071
H-Index - 97
eISSN - 1600-0897
pISSN - 1046-7408
DOI - 10.1111/j.1600-0897.1998.tb00331.x
Subject(s) - medicine , chemotherapy , procarbazine , luteinizing hormone , endocrinology , follicle stimulating hormone , lymphoma , ovulation , testosterone (patch) , gonadotropin , prolactin , radiation therapy , prednisone , goserelin , hormone , vincristine , cyclophosphamide , cancer , breast cancer
PROBLEM: Inhibin A concentrations in serum may reflect the ovarian granulosa cell compartment. To characterize the correlation between ovarian function after gonadotoxic chemotherapy for Hodgkin's or non‐Hodgkin's lymphoma in young women, the immunoreactive inhibin A concentrations in the sera of these patients was measured before, during, and after the gonadotoxic chemotherapy. METHOD OF STUDY: A prospective clinical protocol was undertaken in 20 cycling women with lymphoma, aged 15–40 years. A monthly injection of depot D‐TRP 6 ‐GnRH‐a (Decapeptyl CR, Ferring) was administered from before starting the chemotherapy until its conclusion, up to a maximum of six monthly injections. Most of the patients were treated with the mustargen‐oncovin‐procarbazine‐prednisone (MOPP)/actinomycin D‐bleomycinvincristine (ABV) chemotherapy combination; 13 with and 7 without radiotherapy. A hormonal profile [follicle‐stimulating hormone (FSH), luteinizing hormone (LH), 17‐β‐estradiol (E 2 ), testosterone (T), progesterone (P 4 ), insulin‐like growth factor (IGF)‐1, IGF‐bp 3 , and prolactin (PRL)] was taken before starting the gonadotropin‐releasing hormone agonist (GnRH‐a)/chemotherapy co‐treatment and monthly thereafter until resuming spontaneous ovulation and menstrual cyclicity. This group of prospectively treated lymphoma patients was compared with a control group of 22 regularly cycling women who had been treated with chemotherapy (mostly MOPP/ABV) with or without radiotherapy for Hodgkin's or non‐Hodgkin's lymphoma. Inhibin A immunoactivity developed by Nigel Groome was measured by an enzyme‐linked immunoadsorbent assay (ELISA) commercial kit (Serotec). RESULTS: Whereas all but one (40 years of age) of the surviving patients in the GnRH‐a/chemotherapy co‐treatment group resumed spontaneous ovulation and menses within 6 months, only one half of the patients in the “control” group (chemotherapy without GnRH‐a co‐treatment) resumed ovarian function and regular cyclic activity ( P < 0.05). The remaining 50% experienced premature ovarian failure (POF). Temporarily increased FSH concentrations were experienced by approximately one third of the patients resuming cyclic ovarian function, suggesting a reversible ovarian damage in a larger proportion of women than those experiencing POF. The inhibin A immunoactive concentrations decreased during the GnRH‐a/chemotherapy co‐treatment but increased to normal levels in patients who resumed regular ovarian cyclicity, and/or spontaneously conceived, as compared to low levels in menopausal women and those who had developed POF. CONCLUSIONS: If these preliminary data are consistent in a larger group of patients, inhibin A concentration may serve as a prognostic factor for predicting the resumption of ovarian function, in addition to the levels of FSH, LH, and E 2 .