Reproductive and endocrine gonadal functions in adults following multidrug chemotherapy for acute lymphoblastic or undifferentiated leukemia.

Abstract

The impact of aggressive chemotherapy on reproductive and endocrine gonadal function was studied in ten women and ten men with acute lymphoblastic leukemia (ALL) or acute undifferentiated leukemia (AUL) in complete remission. Hormone determinations, sperm analyses, measurements of basal body temperature, and interviews with a standardized questionnaire were used for diagnostic evaluation. Elevated serum follicle-stimulating hormone (FSH) levels and azoospermia were seen in all male patients after completion of induction and consolidation therapy as a result of germ cell and stem cell loss. Recovery of spermatogenesis, as indicated by normalization of serum FSH values and sperm density, occurred in the second year of maintenance therapy in all men. Serum testosterone and luteinizing hormone (LH) values remained within normal limits indicating resistance of Leydig cells to chemotherapy. All female patients showed normal serum levels of gonadal steroids and gonadotropins, as well as an adequate increase in basal body temperature after intensified chemotherapy, indicating intact follicle function and ovulation. Most patients reported normal sexual functions after induction and consolidation therapy. These results demonstrate that multidrug chemotherapy induced significant impairment of reproductive function in all male patients with early and complete recovery. In contrast, endocrine gonadal function was unaffected in men treated with ALL/AUL. In female patients, neither reproductive nor endocrine functions were influenced by aggressive chemotherapy.

Long-term effects of allogeneic bone marrow transplantation (BMT) on pituitary, gonad, thyroid and adrenal function in adults

“…The dose of irradiation needed to produce permanent sterility in females appears to be related to age, 20 ie the number of remaining oocytes at the time of irradiation, and also to the total dose of radiation and schedule of administration. Gonadal function in males is often more vulnerable than in females 21 after aggressive chemotherapy, and lower doses may cause permanent germinal epithelial damage. The damage causes a constant rise in FSH and infertility in males.…”

“…Males: All males had raised serum basal FSH levels with a mean of 18 U/l (range [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The response of serum FSH to administration of GnRH was abnormally low in all but one patient and delayed in nine, but the curves were flat (Figure 2).…”

“…The LH responses to GnRH were normal and the peak value was most often situated normally. Serum testosterone was normal in all males with the mean of 18 nmol/l (range [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Two of the subjects had abnormally low FAIs (250 and 370), and the mean FAI was within the lower reference range at a mean of 500 (range 250-780; Table 4).…”

Paediatric genitourinary cancers and late effects of treatment

“…46 Alkylating agent chemotherapy and radiation therapy can both cause damage to the germi nal cells. Cancer therapies containing heavy metalssuch as platinumcontaining cisplatin-have also been associated with gonadal dysfunction and resultant infertility despite being atypical.…”

Long-Term Survivors of Childhood Cancer: The Late Effects of Therapy

“…Central nervous system (CNS) radiotherapy or high-dose chemotherapy that achieves suicient CNS levels for the prevention of meningeal leukemia may result in cognitive deicits [24]. Impairment of memory, atention, and visual perceptual motor skills result in problems with language, reading, and arithmetic and poor academic achievement [24,25]. Brain injury may become more apparent years after the completion of therapy and intellectual growth sufers over time [26].…”