Inhibin B is superior to FSH as a serum marker for spermatogenesis in men treated for Hodgkin's lymphoma with chemotherapy during childhood.
BACKGROUND
The aim of this study was to evaluate the long-term gonadal sequelae after treatment for childhood Hodgkin's lymphoma with combination chemotherapy, using up to date fertility parameters and andrological evaluation, including for the first time inhibin B.


METHODS
There were 56 male patients treated from 1974-1998 for childhood Hodgkin's lymphoma with combination chemotherapy ABVD or EBVD (adriamycin/epirubicin, bleomycin, vinblastine, dacarbazine) with or without MOPP (mechlorethamine, vincristin, prednisone, procarbazine) with the intention to avoid radiotherapy. These men were studied 15.5 years (range 5.6-30.2 years) after cessation of therapy. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, testosterone, sex hormone-binding globulin (SHBG), sperm concentration and sperm DNA integrity were determined.


RESULTS
In men treated with MOPP, median FSH and LH were significantly increased (P < 0.001) and inhibin B (17.5 versus 143 ng/l; P < 0.001) and sperm concentration (1.05 versus 49.5 x 10(6)/ml; P < 0.05) were significantly decreased compared with patients treated without MOPP. The number of MOPP courses was significantly correlated with FSH and inhibin B levels. Only inhibin B showed an independent correlation with sperm concentration (r = 0.86; P < 0.001).


CONCLUSIONS
The use of MOPP chemotherapy causes permanent gonadal damage in the far majority of male survivors of childhood Hodgkin's lymphoma and inhibin B is the most valuable serum marker for gonadal function.
van Beek
Robert D
RD
Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Room Sp3435, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
Smit
Marij
M
van den Heuvel-Eibrink
Marry M
MM
de Jong
Frank H
FH
Hakvoort-Cammel
Friederike G
FG
van den Bos
Cor
C
van den Berg
Henk
H
Weber
Rob F A
RF
Pieters
Rob
R
de Muinck Keizer-Schrama
Sabine M P F
SM
D000328:Adult; 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; D005298:Fertility; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006689:Hodgkin Disease / Q000188:drug therapy*; D006801:Humans; D007265:Inhibins / Q000097:blood*; D008297:Male; D008466:Mechlorethamine / Q000009:adverse effects; D011241:Prednisone / Q000009:adverse effects; D011344:Procarbazine / Q000009:adverse effects; D013091:Spermatogenesis; D013997:Time Factors; D014747:Vinblastine / Q000009:adverse effects; D014750:Vincristine / Q000009:adverse effects
D015415:Biomarkers; C422364:inhibin B; D001761:Bleomycin; D011344:Procarbazine; D015251:Epirubicin; D008466:Mechlorethamine; D007265:Inhibins; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D005640:Follicle Stimulating Hormone; D011241:Prednisone