title: Gonadotropin releasing hormone agonists may minimize cyclophosphamide associated gonadotoxicity in SLE and autoimmune diseases.
abstract: OBJECTIVE
  Since young women undergoing cyclophosphamide pulse therapy may suffer premature ovarian failure (POF) in almost 50% of cases, we examined the ability of GnRH-a administration to minimize the gonadotoxicity associated with cyclophosphamide pulse therapy (CPT).
  
  
  METHODS
  Retrospective analysis of medical charts of 44 women (age 16-38 years) who received CPT for autoimmune diseases. In 33 patients a monthly depot injection of GnRH-a was started before the alkylating agent. The ovarian function [spontaneous menstrual bleeding, hormonal profile, (FSH, LH, E(2), progesterone) pelvic sonography, and conceptions] was evaluated, 1 to 10 years after CPT.
  
  
  RESULTS
  In the GnRH-a group, 30 women resumed cyclic ovarian function; 1 (a 37-year-old patient) developed POF (3%), and 2 were lost to follow-up. In the control (no GnRH-a) group, 5 of 11 patients suffered POF (45%). The mean age in the study group was 25.6 ± 5.2 years compared with 29.3 ± 5.8 years in the control group, and the mean cumulative cyclophosphamide dose was 9.9 g compared to 10.9 g, respectively. The difference in the long-term POF remained significant even after adjusting the groups for comparable age and cumulative cyclophosphamide doses.
  
  
  CONCLUSIONS
  GnRH-a decreases cyclophosphamide-associated gonadotoxicity and POF in young women with systemic lupus erythematosus and other autoimmune diseases. Therefore this treatment should be considered and recommended to every young woman before gonadotoxic chemotherapy.
authors.affiliation: Reproductive Endocrinology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. bzeev@techunix.technion.ac.il
authors.forename: Zeev
authors.initials: Z
authors.lastname: Blumenfeld
authors.forename: Or
authors.initials: O
authors.lastname: Mischari
authors.forename: Naomi
authors.initials: N
authors.lastname: Schultz
authors.forename: Nina
authors.initials: N
authors.lastname: Boulman
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir-Gurman
mesh_terms: D000293:Adolescent; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D016649:Primary Ovarian Insufficiency / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D007987:Gonadotropin-Releasing Hormone; D003520:Cyclophosphamide