Risk of Ovarian Failure and Pregnancy Outcome in Patients With Lupus Nephritis Treated With Intravenous Cyclophosphamide Pulse Therapy

Park, J.-C.; Park, Y.-B.; Jung, Sung-Won; Chung, In‐Hyuk; Choi, Kyu Hun; Lee, S.-K.

doi:10.1097/01.ogx.0000154436.51837.4b

Cited by 19 publications

(26 citation statements)

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“…Past trials in patients with SLE and AAV receiving pulse intravenous CYC have demonstrated rates of amenorrhea of 15%-27%, with higher rates of transient amenorrhea in some studies (38,39). This risk may be associated with older age at time of treatment and higher cumulative intravenous CYC doses.…”

Section: Infertilitymentioning

confidence: 98%

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Hogan

Avasare

2014

Clinical Journal of the American Society of Nephrology

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Clinical outcomes in ANCA-associated vasculitis (AAV) and lupus nephritis have improved greatly with treatment regimens containing high-dose glucocorticoids and cyclophosphamide. However, with the use of these medications come significant adverse events, most notably infections, cytopenias, malignancies, and reproductive abnormalities. Multiple recent randomized controlled trials in AAV and lupus nephritis have compared cyclophosphamide-based regimens with agents such as rituximab, mycophenolate mofetil, and azathioprine, with the hope of providing better clinical outcomes with improved safety profiles. Although some of these newer regimens are now considered first-line treatments of these diseases, their adverse event profiles have been disappointingly similar to those of cyclophosphamide-based protocols. Physicians and patients should consider the adverse event profiles generated by these trials in the context of their extensive use in other patient populations, as well as available measures to prevent such events, when choosing the ideal regimen for an individual patient.

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Section: Infertilitymentioning

confidence: 98%

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Hogan

Avasare

2014

Clinical Journal of the American Society of Nephrology

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“…cyclophosphamide for SLE and other rheumatological conditions. While overall fertility is preserved in the majority of women with SLE (Park et al 2004), they require variable treatment dosages over a more prolonged period than malignancies, adding to the difficulties of patient selection. Other appropriate conditions may include sickle cell disease where treatment with total body irradiation (TBI) is proposed (Donnez et al 2006a).…”

Section: Patient Outcomesmentioning

confidence: 99%

Ovarian cryopreservation for fertility preservation: indications and outcomes

Anderson¹,

Wallace²,

Baird³

2008

Reproduction

121

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Female fertility preservation provides significantly different challenges to that for the male, with the only established method being cryopreservation of embryos thus necessitating the involvement of a male. Other, experimental, options include oocyte or ovarian tissue cryopreservation. The latter has been regarded as a potential method for more than a decade, but has resulted in the birth of only five babies. It is not possible to be certain how many women have had ovarian tissue cryopreserved. Oocyte cryopreservation also remains experimental, but w100-fold more babies have been born through this technique over the last two decades. Ovarian tissue cryopreservation has the potential advantages of preservation of a large number of oocytes within primordial follicles, it does not require hormonal stimulation when time is short and indeed may be appropriate for the pre-pubertal. Disadvantages include the need for an invasive procedure, and the uncertain risk of ovarian contamination in haematological and other malignancies. We here review this approach in the context of our own experience of 36 women, highlighting issues of patient selection especially in the young, and uncertainties over the effects of cancer treatments on subsequent fertility. Of these 36 women, 11 have died but 5 have had spontaneous pregnancies. So far, none have requested reimplantation of their stored ovarian tissue. Ovarian cryopreservation appears to be a potentially valuable method for fertility preservation, but the indications and approaches best used remain unclear.Reproduction (2008) 136 681-689

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“…Several studies of women with lupus found premature ovarian failure rates between 16% and 54%, with an average of 30%. [22][23][24][25][26] Both age at the time of CYC therapy and the cumulate dose of the drug were the main determinants of risk for ovarian failure, with the risk sharply increasing over age 30 and with doses over 10 g. 22,23 This meta-analysis includes studies with varying intensities and types of chemotherapy, making comparisons between studies difficult. It does, however, allow the results to be more generalizable, demonstrating that GnRHa may be effective during a variety of chemotherapeutic regimens.…”

Section: Clowse Et Almentioning

confidence: 99%

Ovarian Preservation by GnRH Agonists during Chemotherapy: A Meta-Analysis

Clowse

Behera

Anders

et al. 2009

Journal of Women's Health

202

121

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Purpose: Treatment with cyclophosphamide (CYC) confers up to a 40% risk of ovarian failure in women of reproductive age. The use of GnRH agonists (GnRHa) to preserve ovarian function has been investigated in several small studies. We performed a systematic review of studies examining whether a GnRHa administered during chemotherapy is protective of ovarian function and fertility. Methods: We searched the English-language literature (1966( -April 2007 using MEDLINE and meeting abstracts and included studies that reported an association between GnRHa and ovarian preservation in women receiving chemotherapy. Studies without a control group were excluded. Ovarian preservation was defined as the resumption of menstrual cycles and a premenopausal follicle-stimulating hormone (FSH) after chemotherapy. Fertility was determined by a woman's ability to become pregnant. We estimated the summary relative risk (RR) and associated 95% confidence intervals (95% CI) using a random-effects model. Results: Nine studies included 366 women. Three studies included women with autoimmune disease receiving CYC; six included women with hematologic malignancy receiving combination chemotherapy. In total, 178 women were treated with GnRHa during chemotherapy, 93% of whom maintained ovarian function. Of the 188 women not treated with GnRHa, 48% maintained ovarian function. The use of a GnRHa during chemotherapy was associated with a 68% increase in the rate of preserved ovarian function compared with women not receiving a GnRHa (summary RR ¼ 1.68, 95% CI 1.34-2.1). Among the GnRHa-treated women, 22% achieved pregnancy following treatment compared with 14% of women without GnRHa therapy (summary RR ¼ 1.65, CI 1.03-2.6). Conclusions: Based on the available studies, GnRHa appear to improve ovarian function and the ability to achieve pregnancy following chemotherapy. Several randomized trials are underway to define the role and mechanism of GnRHa in ovarian function preservation. In the meantime, premenopausal women facing chemotherapy should be counseled about ovarian preservation options, including the use of GnRHa therapy.

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Risk of Ovarian Failure and Pregnancy Outcome in Patients With Lupus Nephritis Treated With Intravenous Cyclophosphamide Pulse Therapy

Cited by 19 publications

References 0 publications

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Is Newer Safer? Adverse Events Associated with First-Line Therapies for ANCA-Associated Vasculitis and Lupus Nephritis

Ovarian cryopreservation for fertility preservation: indications and outcomes

Ovarian Preservation by GnRH Agonists during Chemotherapy: A Meta-Analysis

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