title: Semen quality and fertility in adult long-term survivors of childhood acute lymphoblastic leukemia.
abstract: OBJECTIVE
  To assess testicular function and its determinants in adult survivors of childhood acute lymphoblastic leukemia (ALL) at a median time of 20 years after ALL therapy.
  
  
  METHODS
  Prospective investigation.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifty-one male long-term survivors and 56 age-matched controls (median age of survivors at ALL diagnosis was 5 years, range: 1 to 15 years, and at the study 29 years, range: 26 to 38 years).
  
  
  METHODS
  None.
  
  
  METHODS
  Testicular size (mean value of both testicular volumes), serum hormone concentrations, semen quality, and number of children fathered correlated with ALL therapy.
  
  
  RESULTS
  Survivors treated with 0-10 g/m(2) of cyclophosphamide had sperm quality and fertility rates comparable with those of controls, but the serum free-testosterone in the survivors treated with cyclophosphamide was lower than in controls (median: 213 pmol/L, range: 189-260 vs. 296 pmol/L, range: 242-338, respectively). Cranial irradiation without cyclophosphamide did not affect semen quality, fertility, or testosterone levels. None of the survivors of a high cumulative dose of cyclophosphamide (>20 g/m(2)) and testicular irradiation (10-24 Gy) had fathered a child. Testicular size was shown to be better than serum inhibin B in predicting nonazoospermic semen samples or fertility.
  
  
  CONCLUSIONS
  Treatment of childhood ALL with 0-10 g/m(2) of cyclophosphamide and cranial irradiation does not affect fertility or semen quality but may impair long-term Leydig cell function.
authors.affiliation: Division of Hematology-Oncology and Stem Cell Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. kirsi.jahnukainen@ki.se
authors.forename: Kirsi
authors.initials: K
authors.lastname: Jahnukainen
authors.forename: Risto
authors.initials: R
authors.lastname: Heikkinen
authors.forename: Markus
authors.initials: M
authors.lastname: Henriksson
authors.forename: Trevor G
authors.initials: TG
authors.lastname: Cooper
authors.forename: Leena-Riitta
authors.initials: LR
authors.lastname: Puukko-Viertomies
authors.forename: Outi
authors.initials: O
authors.lastname: Mäkitie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use; D005298:Fertility / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy*; D011446:Prospective Studies; D012661:Semen / Q000187:drug effects / Q000528:radiation effects; D055101:Semen Analysis / Q000379:methods*; D017741:Survivors; D013737:Testis / Q000187:drug effects / Q000528:radiation effects
chemical_list: D003520:Cyclophosphamide