Pregnancy outcome after treatment for acute lymphoblastic leukemia during childhood or adolescence

Abstract

To evaluate gonadal function and pregnancy outcome after treatment for acute lymphoblastic leukemia during childhood or adolescence, 44 former patients who were less than 20 years of age at diagnosis, 5 or more years from diagnosis, and 18 or more years of age were contacted. Thirty-nine (88%) provided information regarding pregnancy outcome. Gonadal function as estimated by the ability to conceive or sire a pregnancy, was not impaired despite treatment with substantial cumulative doses of methotrexate, 6-mercaptopurine, vincristine, and 1-asparaginase. Twelve patients reported a total of 27 pregnancies. There were four spontaneous abortions, one stillborn, and 22 liveborn infants. The birthweights were 1928 to 4536 g (median, 3430 g). Two infants had congenital anomalies. The childrens' ages ranged from 1 month to 10 years, 2 months (median, 6 years, 1 month). None has been diagnosed with any type of childhood cancer. The results of this study suggest that pregnancy outcome is not affected adversely by treatment received during childhood or adolescence for acute lymphoblastic leukemia.

A fixed-jaw method to protect critical organs during intensity-modulated radiotherapy

“…Whole-abdomen irradiation causes severe ovarian damage. 8 As reported by Wallace et al, 9 71% of women in one series failed to enter puberty, and 26% had premature menopause following whole-abdominal radiation therapy doses of 2 to 3 Gy. The studies by Stillman et al 10 and Peck et al 11 indicate that the frequency of ovarian failure is correlated not only with the treatment volume but also with the radiation therapy dose.…”

Sites of Failure in Breast Cancer Patients with Extracapsular Invasion of Axillary Lymph Node Metastases

“…Ovarian failure is observed also when using combination chemotherapy alone. A number of drugs carry a particularly high risk of inducing ovarian failure, i.e., cyclophosphamide, ifosfamide, cisplatinum, vinblastine, busulfan, BCNU, and CCNU [7,11,17,23,29]. Drugassociated ovarian failure is dose-and age-dependent [25] -older patients having a higher risk of gonadal damage [1,12].…”

“…This surgical procedure takes the ovary out of the high dose area of irradiation and may therefore reduce radiation-associated side effects to the reproductive organs [5,6,8,19]. Apart from radiotherapy, ovarian function can be impaired by ovariopexy itself and also by various chemotherapeutic agents [7,11,15,17,23,29].…”

Anticancer chemotherapy in teenagers and young adults: managing long term side effects

“…18 For example, the MOPP (Mustargen, Oncovin, procarbazine, prednisone) regimen for treating Hodgkin's lymphoma included alkylating agents and led to 20% amenorrhoea rates in women. 19 The Childhood Cancer Survivor Study found the relative risk of long term survivors becoming pregnant was 0.81 compared with healthy sibling controls. TYAs comprised 20% of the study cohort.…”