title: Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Hematology/Oncology, Children's National Medical Center, Washington, DC 20010, USA. jbyrne@cnmc.org
authors.forename: Julianne
authors.initials: J
authors.lastname: Byrne
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Fears
authors.forename: James L
authors.initials: JL
authors.lastname: Mills
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Charles
authors.initials: C
authors.lastname: Sklar
authors.forename: H Stacy
authors.initials: HS
authors.lastname: Nicholson
authors.forename: Riccardo
authors.initials: R
authors.lastname: Haupt
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Reaman
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005298:Fertility; D006801:Humans; D008572:Menarche / Q000528:radiation effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000503:physiopathology / Q000532:radiotherapy*; D011247:Pregnancy; D012189:Retrospective Studies