OVARIAN FOLLICULAR CELL AMH PRODUCTION IS TRANSIENTLY AFFECTED IN MOST OF THE GIRLS WITH ACUTE LYMPHOBLASTIC LEUKEMIA AND LYMPHOBLASTIC LYMPHOMA RECEIVING CHEMOTHERAPY

AROZARENA DE GAMBOA M; GUTIERREZ M; BALLERINI MG; REY RA; BEDECARRÁS P; ARCARI A; AVERSA L; PRADA S; ROPELATO MG; GRYNGARTEN MG; GRINSPON RP

Washington

Congreso; 10th International Meeting of Pediatric Endocrinology; 2017

ESPE-SLEP

Objectives: Improvements in the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LL) have increased survival. Concern has therefore arisen over the long-term effects that chemotherapy in childhood may have on ovarian function. The main objective was evaluate small ovarian follicle status in girls. Methods: We measured serum AMH in a prospective cohort. Main outcome measure was the prevalence rate of decrease in serum AMH after each phase of chemotherapy, every 6 months during maintenance and 1 year after treatment completion. Secondarily, gonadotropin and estradiol levels were analyzed. Results of continuous variables are expressed as medians (range). Results: Thirty-four girls were included; 31 with ALL (4 standard-, 19 medium- and 8 high-risk ALL) and 3 with LL. At diagnosis, age was 5.9 yr (0.2-15.7), 24 were prepubertal and 10 pubertal. Follow-up was 1.1 yr (0.25- 3.5). Decreased serum AMH was observed in 29/34 (85%) patients. In 8 patients (23.5%) decreased AMH was seen at diagnosis, and in 21 cases during chemotherapy treatment. Out of the 29 patients that presented low AMH levels, 19 (65.5%) recovered normal serum AMH: 9 (47.4%) during intravenous chemotherapy, 8 (42.1%) during maintenance and 2 (10.5%) after the end of treatment. No difference in the proportion of patients with decreased AMH was found between patients with high risk LLA (84.7%) and with standard or medium risk ALL (87.5%). LH was increased in 9 patients (5 prepubertal and 4 pubertal) and FSH in 10 patients (7 prepubertal and 3 pubertal). In all cases, gonadotrophins increased transiently and mildly. Estradiol was not informative. Conclusions: These preliminary results suggests that most girls with ALL or LL suffered a transient dysfunction of small ovarian follicles during chemotherapy, with recovery in approximately two-thirds of the cases.