Sertoli Cell Function Was Not Affected by Chemotherapy in Boys with Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma

GRINSPON RP; PRADA, S; SANZONE, M; BEDECARRAS PATRICIA; GIL, G; GUTIERREZ, M; MORALES, M; GOTTLIEB S; BERGADÁ I; AVERSA,L; REY, R

Playa del Carmen

Congreso; XXIV Reunión de la Sociedad Latinoamericana de Endocrinología Pediátrica; 2014

Introduction: Testicular germ cells are highly sensitive to chemotherapy, while precursors of Leydig cells in prepubertal boys would be less affected. However, it is not known yet if chemotherapy affects Sertoli cells, whose function is essential for normal pubertal and adult spermatogenesis. The objective of this work was to evaluate the function of the Sertoli cell in children and adolescent survivors of Acute Lymphoblastic Leukemia (ALL) or Lymphoblastic Lymphoma (LL) who received polichemotherapy. Study Design and Methods: We performed a retrospective cross-sectional study in male survivors of ALL or LL treated with polichemotherapy at hematology Unit of R. Gutiérrez Children?s Hospital between 2004 and 2012. Exclusion: patients with incomplete laboratory results or ALL relapse. Patients were classified into 3 risk groups according to hematologic characteristics at diagnosis: High, Intermediate or Standard risk. Treatment was adapted to each risk group. The main outcome measure was serum Anti-Müllerian Hormone (AMH). Results were expressed as median and range of SDS according to published reference values [1]. Secondarily, FSH values were analyzed as an indirect Sertoli cell marker. Results: Out of 55 children (LLA: 52 and LL: 3), 18 had standard risk, 30 intermediate risk and 7 high risk. Median age at start of chemotherapy was 6.7 years (range 1.8 to 16.7). Treatment duration was 2.2 years (range 0.8 to 3.3). 31 patients completed treatment before the age of 10 years and 24 after the age of 10 years. Last hormonal evaluation was 3.0 years (range 1.1 to 12.1) after treatment. Within the first year after termination of chemotherapy, 29 patients were evaluated; AMH concentration was at ?0.09 SDS (?1.31 to 4.92). Between the 2nd and 6th year, 30 patients were evaluated; AMH was at ?0.36 SDS (?1.07 to 1.66). In 13 patients evaluated 6 to 12 years after chemotherapy completion AMH was at ?0.56 SDS (?1.24 to ?1.45). Differences between the three time periods of evaluation were not significant, and no patient had a concentration of AMH 97th centile. All patients with high FSH were older than 11 years of age. AMH level in these patients was at ?0.48 SDS (?1.24 to 1.45). Conclusion: Sertoli cell function by means of their ability to secrete AMH was not damaged in children with ALL or LL who received polichemotherapy. This result provides insight for con-servation of germ cells in boys submitted to chemotherapy, since the procedure requires a Sertoli cell population with appropriate function for normal spermatogenesis to be reestablished Downloaded by: 190.195.119.183 - 5/21/2015 8:47