Anti-Mullerian hormone is a sensitive serum marker for gonadal function in women treated for Hodgkin's lymphoma during childhood.
OBJECTIVE
The aim of this study was to evaluate the long-term effects of combination chemotherapy treatment for girls with Hodgkin's lymphoma (HL) on gonadal function using anti-Müllerian hormone (AMH) and inhibin B as ovarian reserve parameters.


METHODS
LH, FSH, inhibin B, and AMH were measured in 32 women treated from 1974 to 1998 for pediatric HL with chemotherapy, with the intention to avoid radiotherapy. All patients [median age 25.0 yr (range 19.2-40.4 yr)] were in complete remission with a median follow-up time of 14.0 yr (range 5.7-24.5 yr) after therapy. All patients were treated with combination chemotherapy doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) or EBVD with or without mechlorethamine, vincristine, procarbazine, and prednisone (MOPP). Because of incomplete remission or relapse, involved field radiotherapy was needed in seven of 32 women. Results were compared with a healthy control group.


RESULTS
Patients treated with six or more cycles of MOPP combination chemotherapy had significantly higher levels of FSH and lower serum levels of inhibin B and AMH, compared with healthy women [FSH, 17.0 vs. 6.0 U/liter (P < 0.05); inhibin B, 23.0 vs. 112.5 ng/liter (P < 0.01); AMH, 0.39 vs. 2.10 microg/liter (P < 0.01)]. AMH was also significantly lower, compared with women treated without MOPP (median 0.39 vs. 1.40 microg/liter; P = 0.01).


CONCLUSIONS
Women treated during childhood for HL with MOPP seem to have a distinctly lower ovarian reserve as measured by lower AMH values at early adulthood, compared with healthy women. Moreover, AMH seems to be the only predictor that is sufficiently sensitive to detect this decrease in ovarian reserve.
van Beek
Robert D
RD
Department of Pediatric Hematology/Oncology , Erasmus MC Rotterdam, The Netherlands.
van den Heuvel-Eibrink
Marry M
MM
Laven
Joop S E
JS
de Jong
Frank H
FH
Themmen
Axel P N
AP
Hakvoort-Cammel
Friederike G
FG
van den Bos
Cor
C
van den Berg
Henk
H
Pieters
Rob
R
de Muinck Keizer-Schrama
Sabine M P F
SM
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D054304:Anti-Mullerian Hormone / Q000097:blood*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood*; D001761:Bleomycin / Q000009:adverse effects; D002648:Child; D003606:Dacarbazine / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D015251:Epirubicin / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000009:adverse effects; D010053:Ovary / Q000187:drug effects / Q000502:physiology; D011237:Predictive Value of Tests; D011241:Prednisone / Q000009:adverse effects; D011247:Pregnancy; D016649:Primary Ovarian Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D011344:Procarbazine / Q000009:adverse effects; D012074:Remission Induction; D014747:Vinblastine / Q000009:adverse effects; D014750:Vincristine / Q000009:adverse effects
D015415:Biomarkers; D001761:Bleomycin; D011344:Procarbazine; D015251:Epirubicin; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D054304:Anti-Mullerian Hormone; D011241:Prednisone