INVESTIGADORES
GRINSPON Romina
congresos y reuniones científicas
Título:
Sertoli cell function was not affected by chemotherapy in boys with Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma.
Autor/es:
GRINSPON R; PRADA S; SANZONE M; BEDECARRÁS P; GIL G.; GUTIERREZ M.; MORALES M.; GOTTLIEB S.; BERGADÁ I.; AVERSA L.; REY R.
Lugar:
Playa del Carmen
Reunión:
Congreso; XXIV Reunión de la Sociedad Latinoamericana de Endocrinología Pediátrica; 2014
Institución organizadora:
SLEP
Resumen:
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 <2 SDS. (Kruskal-Wallis p: 0.38)
We did not find differences in AMH according to
baseline risk, while n of patients at high risk was only 7.
7% of patients were evaluated within 1 year after
chemotherapy completion and 16% of those evaluated after 1 year had an FSH >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 conservation 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.