title: Acute onset of ovarian dysfunction in young females after start of cancer treatment.
abstract: BACKGROUND
  Female childhood cancer survivors are at risk of ovarian failure and premature ovarian insufficiency. We hereby present an interim analysis of a prospective observational study of ovarian function during cancer treatment of young females in relation to clinical factors.
  
  
  METHODS
  Thirty-four consecutive female cancer patients aged 0-18 year were included after informed consent. Serum/Plasma levels of anti-Müllerian hormone (AMH), inhibin B, FSH, LH, and oestradiol (E2) were measured at diagnosis and every 3-4 months during and after treatment.
  
  
  RESULTS
  All patients had detectable AMH levels at diagnosis. Eleven patients had reached menarche (mean age 14½ years) and the remaining patients had a mean age of 6½ years. They all showed a rapid decline in AMH after 3 months of treatment, regardless of AMH at diagnosis, age, menarche, or treatment given. Those given radiotherapy below the diaphragm and/or stem cell transplantation (SCT) (n = 9) had no ovarian recovery during or 1½-year after treatment. However, recovery was observed in those given standard treatment for acute lymphatic leukemia (n = 7) already during maintenance chemotherapy. For the remaining patients, longer follow-up is required for analysis of ovarian recovery after treatment.
  
  
  CONCLUSIONS
  Rapid ovarian dysfunction is observed in all females after initiation of cancer treatment as measured by AMH and inhibin B. Our data regarding those who require abdominal radiotherapy and/or SCT confirms the recommendations in the Nordic countries where these patients are eligible for cryopreservation of ovarian cortical tissue before start of cancer treatment.
authors.affiliation: Department of Pediatric Oncology and Hematology, Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Mörse
authors.forename: Maria
authors.initials: M
authors.lastname: Elfving
authors.forename: Anna
authors.initials: A
authors.lastname: Lindgren
authors.forename: Pål
authors.initials: P
authors.lastname: Wölner-Hanssen
authors.forename: Claus Yding
authors.initials: CY
authors.lastname: Andersen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Øra
mesh_terms: D000293:Adolescent; D054304:Anti-Mullerian Hormone / Q000097:blood*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood*; D007986:Luteinizing Hormone / Q000097:blood; D009369:Neoplasms / Q000188:drug therapy*; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced*
chemical_list: D000970:Antineoplastic Agents; C422364:inhibin B; D004958:Estradiol; D007265:Inhibins; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone