[Anti-mullerian hormone in young women after chemotherapy and infradiaphragmatic radiotherapy for childhood cancer].
BACKGROUND
Composed anticancer treatment leads to different late effects, such as ovarian failure, causing infertility or premature menopause.


OBJECTIVE
was to analyse ovarian function, particularly anti-mullerian hormone levels, in young females after anticancer treatment.


METHODS
We analysed FSH, LH, estradiol and anti-mullerian hormone (AMH) levels on days 3-5 of a menstrual cycle in thirty three cancer survivors in mean age 19.1+/-4.7 years treated in age 12.0+/-5.6 years for Hodgkin Lymphoma (HL) (n=16), nephroblastoma (n=7), soft tissue sarcoma (n=4), germinal tumor (n=3), neuroblastoma (n=2), histiocytosis (n=1). Infradiaphragmatic radiotherapy was needed in 16 patients (10 treated for HL). Results were compared with healthy girls of the same age.


RESULTS
The mean values of FSH, LH, E2 and AMH did not differ in all survivors comparing to controls. Patients treated for HL with chemo- and radiotherapy presented higher FSH levels than controls (8.53+/-3.25 vs. 5.8+/-2.03 mIU/ml; p=0.045). Mean AMH levels were lower in all patients that received radiotherapy for the infradiaphragmatic region (17.19+/-14.84 pmol/l) than in controls (29.40+/-13.2 pmol/l; p=0.037). Particular analysis of all cases showed higher (>2 SD) FSH levels in 8 patients: 5 patients treated for HL with radiotherapy and higher total doses of procarbazine, nitrogen mustard and vinblastine; 2 patients treated for soft tissue sarcoma and one patient for Wilms tumor (all received radiotherapy). Lowered AMH levels were found in 8 patients treated with chemo- and radiotherapy (4 - for HL, 2 - for Wilms tumor and 2 - for soft tissue sarcoma).


CONCLUSIONS
Composed anticancer treatment, especially radiotherapy, leads to ovarian failure. Decreased AMH values at young adulthood suggest a lower ovarian reserve. All causes and first symptoms of ovary damage should be known to the doctors who take care of the patients after anticancer treatment.
Krawczuk-Rybak
Maryna
M
Klinika Onkologii Dzieciecej UM w Bialymstoku, Bialystok, Poland. rybak@amb.edu.pl
Leszczyńska
Elzbieta
E
Wysocka
Jolanta
J
Zelazowska-Rutkowska
Beata
B
D000293:Adolescent; D000328:Adult; D054304:Anti-Mullerian Hormone / Q000378:metabolism*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005260:Female; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D008594:Menopause, Premature; D009369:Neoplasms / Q000628:therapy; D010053:Ovary / Q000187:drug effects / Q000528:radiation effects; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors
D054304:Anti-Mullerian Hormone; D005640:Follicle Stimulating Hormone