Early Detection of Ovarian Dysfunction by Anti-Mullerian Hormone in Adolescent and Young Adult-Aged Survivors of Childhood Cancer

George, Sobenna A.; Lewis, Rebecca Williamson; Schirmer, David; Effinger, Karen E.; Spencer, Jessica B.; Mertens, Ann C.; Meacham, Lillian R.

doi:10.1089/jayao.2018.0080

Cited by 23 publications

(9 citation statements)

References 51 publications

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“…We used a nonvalidated infertility risk stratification system, based solely on expert opinion, to descriptively characterize the level of gonadotoxic therapy that our patients received, and therefore patients’ risk for future infertility could be misclassified. While this stratification system was well correlated with measures of ovarian reserve and function in a previous study at our institution using a similar patient demographic, it has not been linked to pregnancy outcomes. Our definition of respondent‐reported POI included survivors who did not independently report ovarian failure but whose stated that the reason for HRT was ovarian failure.…”

Section: Discussionmentioning

confidence: 99%

Assessment of ovarian function in adolescents and young adults after childhood cancer treatment—How accurate are young adult/parent proxy‐reported outcomes?

George

Lewis

McKenzie

et al. 2019

Pediatric Blood & Cancer

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Background : Providers often rely on self‐reported ovarian function in adolescent and young adult (AYA)‐aged childhood cancer survivors when making clinical decisions. This study described reported menstrual patterns and the agreement between respondent‐reported and biochemical premature ovarian insufficiency (POI) in this population. Procedure This was a cross‐sectional study of survivors (or their parent proxy) aged 13‐21.9 years who received gonadotoxic therapy and were enrolled in a longitudinal health survey. Participants reported menstrual regularity, hormone‐replacement therapy (HRT) use, and ovarian dysfunction. Respondent‐reported POI was defined as the survivor taking HRT for ovarian failure or having been told she had ovarian failure. Biochemical POI was defined as follicle‐stimulating hormone (FSH) level ≥40 mIU/mL. The agreement between respondent‐reported and biochemical POI was determined using Cohen's kappa coefficient (κ) and analyzed by demographic and clinical factors. Results Among 182 AYA‐aged survivors (72.5% non‐Hispanic White, 46.7% leukemia survivors), 14.8% reported requiring HRT to have menses but 55.5% reported regular menses without HRT use. Among survivors with FSH measurements (n = 130), 17.7% reported POI whereas 18.5% had FSH ≥40 mIU/mL (κ = 0.66, sensitivity 70.8%, specificity 94.3%). The highest agreement between respondent‐reported and biochemical POI was with young adult self‐report (κ = 0.78) and survivors with >5 survivor clinic (κ = 0.83) and/or >5 endocrinologist (κ = 1.00) visits. Conclusions The majority of AYA‐aged survivors reported having regular menses without HRT support. The accuracy of respondent‐reported POI increased with repeated survivor clinic or endocrinologist visits, highlighting the importance of continued education. Survivors must be informed about their ovarian function to enable them to advocate for their reproductive health.

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Section: Discussionmentioning

confidence: 99%

Assessment of ovarian function in adolescents and young adults after childhood cancer treatment—How accurate are young adult/parent proxy‐reported outcomes?

George

Lewis

McKenzie

et al. 2019

Pediatric Blood & Cancer

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“…Serum AMH is low during childhood gradually rising to reach a plateau in the midtwenties after which it declines to the menopause (Kelsey et al, Li Fong et al, 2012, Broer et al, 2014, Anderson, 2012. AMH measurement represents the ovarian reserve in all age groups and is independent of the menstrual cycle (Brougham et al, 2012;Anderson 2012;George et al, 2019). lnhibin B, produced by Sertoli cells in the seminiferous tubules of the testis is positively correlated with spermatogenesis in adult males (Pierik et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Anti-Müllerian hormone and Inhibin B after stem cell transplant in childhood: a comparison of myeloablative, reduced intensity and treosulfan-based chemotherapy regimens

Leiper

Houwing

Davies

et al. 2020

Bone Marrow Transplant

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Serum concentrations of Anti-Mullerian Hormone (AMH) and Inhibin B, along with pubertal status, hormone replacement and pregnancy data were used to assess potential fertility in survivors of childhood HSCT after three chemotherapy-conditioning regimens of differing intensity. Of 428 patients transplanted at GOSH between 1990-2012 for leukaemia and immunodeficiency, 121 survived >1 year after a single HSCT conditioned with one of 3 regimens: Group A had a Treosulfan-based regimen (low-toxicity); Group B had Fludarabine/Melphalan (Flu-Mel) (reduced-intensity) and Group C had Busulphan/Cyclophosphamide (Bu-Cy) (myelo-ablative). Mean age at HSCT and follow-up were 3.6 and 11.8 years. Mean length of follow-up was 9.9 years. The mean AMH SD scores were significantly higher in Group A (-1.047) and Group B (-1.255) than Group C (-1.543), suggesting that ovarian reserve was less impaired after Treosulfan and Flu-Mel than after Bu-Cy. The mean serum AMH concentration was significantly better with Treosulfan than with Flu-Mel or Bu-Cy and >1.0 microg/l. In males, mean Inhibin B SD scores were significantly higher in Group A (-0.506) than in Group B (-2.53) and Group C (-1.23) with the Flu-Mel group suffering the greatest impairment. In conclusion, a Treosulfan-based regimen confers a more favourable outlook for gonadal reserve than Flu-Mel or Bu-Cy in both sexes. Significantly higher values of Inhibin B after Bu-Cy than after Flu-Mel may reflect recovery over time.

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“…Several studies have reported the use of AMH in evaluating ovarian reserve in pediatric cancer patients who have undergone gonadotoxic therapy. [31][32][33][34][35] However, while these studies collectively suggest that AMH is a sensitive marker for damage to the ovarian reserve, there are currently little data regarding how and when to use AMH as a screening tool in the survivorship population. In fact, current surveillance recommendations in female childhood cancer survivors from the International Late Effects of Childhood Cancer Guideline Harmonization Group do not recommend using AMH as a primary surveillance modality for primary ovarian insufficiency.…”

Section: Future Best Practices Committee Initiativesmentioning

confidence: 99%

2019 Pediatric Initiative Network: Progress, Proceedings, and Plans

Nahata

Gómez-Lobo

Meacham

et al. 2020

Journal of Adolescent and Young Adult Oncology

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Impairment of fertility and sexual/reproductive health are common after oncologic therapy, and are known to have negative impacts on romantic relationships and psychosocial well-being among childhood cancer survivors. The Pediatric Initiative Network (PIN) is an international, multidisciplinary group of providers within the Oncofertility Consortium dedicated to preserving and protecting the fertility of children and adolescents at risk for infertility due to medical conditions or treatments. The PIN and its Best Practices and Research committees meet virtually throughout the year, with one annual in-person meeting. The purpose of this ''proceedings'' is to highlight key discussion points from the annual PIN meeting which took place on November 11, 2019, to 1) provide a context for pediatric groups across the country on what oncofertility programs are currently doing and why, and 2) inform stakeholders of past, present and future initiatives that may be of value to them and the patient populations they serve.

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Early Detection of Ovarian Dysfunction by Anti-Mullerian Hormone in Adolescent and Young Adult-Aged Survivors of Childhood Cancer

Cited by 23 publications

References 51 publications

Assessment of ovarian function in adolescents and young adults after childhood cancer treatment—How accurate are young adult/parent proxy‐reported outcomes?

Assessment of ovarian function in adolescents and young adults after childhood cancer treatment—How accurate are young adult/parent proxy‐reported outcomes?

Anti-Müllerian hormone and Inhibin B after stem cell transplant in childhood: a comparison of myeloablative, reduced intensity and treosulfan-based chemotherapy regimens

2019 Pediatric Initiative Network: Progress, Proceedings, and Plans

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