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Handelsman DJ, Idan A, Sleiman S, Bacha F, Long GV, Menzies AM, Vaishnav T, Litkouhi N, Volckmar X, Ledger W, Anazodo A. Testicular function after non-cytotoxic and immunotherapy drug treatment. Andrology 2024; 12:891-898. [PMID: 37889046 DOI: 10.1111/andr.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The effects of novel non-cytotoxic and immunotherapy drugs for cancer treatment on human testicular function have not been studied systematically. OBJECTIVES The present study aimed to characterize effects of non-cytotoxic and immunotherapy drugs in patients with cancers who had not been previously treated with gonadotoxic chemo- or radiotherapy. MATERIALS AND METHODS This study involved 34 men, not previously treated with gonadotoxic regimens, in a mixed longitudinal (Cohort 1: 19 men about to start and approximately 1 year on non-cytotoxic and immunotherapy treatment) and cross-sectional (Cohort 2: 15 men already on non-cytotoxic and immunotherapy treatment) study using data modeling to estimate within-person time-course changes in testicular exocrine and endocrine functions. Cohort 1 provided 45 paired semen and blood samples (34 prior to and nine during treatment) and Cohort 2 provided 45 sets of samples (15 pre-treatment, 30 on treatment), including six men in Cohort 2 who had pre-treatment spermatozoa cryostorage prior to the study. Men on non-cytotoxic and immunotherapy treatment had undergone a median of 33.5 months long-term treatment. RESULTS Spermatozoa output and concentration were reduced by about 50%, with corresponding increases in serum follicle-stimulating hormone and decreases in serum inhibin B. Serum testosterone, luteinizing hormone, and sex hormone-binding globulin were unaffected by non-cytotoxic and immunotherapy treatment. CONCLUSION Within limits of the present study of sample size and duration of on-non-cytotoxic and immunotherapy treatment, non-cytotoxic and immunotherapy drugs have a modest effects on testicular exocrine function (sperm production) or its hormonal correlates (follicle-stimulating hormone, inhibin B), with minimal impact on testicular endocrine (testosterone, luteinizing hormone) function.
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Affiliation(s)
- David J Handelsman
- Andrology Department and Clinical Andrology Laboratory, Concord Hospital, Sydney, New South Wales, Australia
- ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Amanda Idan
- Andrology Department and Clinical Andrology Laboratory, Concord Hospital, Sydney, New South Wales, Australia
| | - Sue Sleiman
- Andrology Department and Clinical Andrology Laboratory, Concord Hospital, Sydney, New South Wales, Australia
| | - Fey Bacha
- Andrology Department and Clinical Andrology Laboratory, Concord Hospital, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute of Australia, University of Sydney, Royal North Shore & Mater Hospitals, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute of Australia, University of Sydney, Royal North Shore & Mater Hospitals, Sydney, New South Wales, Australia
| | - Tejnei Vaishnav
- School of Women's and Childrens Health, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Noosha Litkouhi
- School of Women's and Childrens Health, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Xanthie Volckmar
- School of Women's and Childrens Health, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - William Ledger
- School of Women's and Childrens Health, Royal Hospital for Women, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Antoinette Anazodo
- School of Women's and Childrens Health, Royal Hospital for Women, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children's Hospital, Sydney, New South Wales, Australia
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Moravek MB, Pavone ME, Burns K, Kashanian JA, Anderson RA, Klosky JL, Rotz SJ, Stern CJ, Rodriguez-Wallberg KA, Levine JM, Meacham LR. Fertility assessment and treatment in adolescent and young adult cancer survivors. Pediatr Blood Cancer 2023; 70 Suppl 5:e28854. [PMID: 37381152 DOI: 10.1002/pbc.28854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/23/2020] [Accepted: 12/04/2020] [Indexed: 06/30/2023]
Abstract
In the survivorship setting, adolescent and young adult (AYA) cancer survivors frequently demonstrate little knowledge of infertility risk, are unclear regarding their fertility status, and may under- or overestimate their treatment-related risk for infertility. In female AYA survivors, ovarian function usually parallels fertility, and can be assessed with serum hormone levels and ultrasonography. Posttreatment fertility preservation may be appropriate for survivors at risk for primary ovarian insufficiency. In male AYA survivors, fertility and gonadal function are not always equally affected, and can be assessed with a semen analysis and serum hormones, respectively. As reproductive health issues are commonly cited as an important concern by survivors of AYA cancer, multidisciplinary care teams including oncology, endocrinology, psychology, and reproductive medicine are advocated, with the aim of optimal provision of fertility advice and care for AYA cancer survivors.
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Affiliation(s)
- Molly B Moravek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Mary Ellen Pavone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Burns
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - James L Klosky
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Seth J Rotz
- Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Catharyn J Stern
- Melbourne IVF, East Melbourne, Victoria, Australia
- The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Kenny A Rodriguez-Wallberg
- Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Solna, Sweden
| | - Jennifer M Levine
- Division of Pediatric Hematology/Oncology, Cornell University Joan and Sanford I Weill Medical College, New York, New York
| | - Lillian R Meacham
- Aflac Cancer Center, Children's Healthcare of Atlanta, Atlanta, Georgia
- Department of Pediatrics, Division of Hematology/Oncology and Endocrinology, Emory University School of Medicine, Atlanta, Georgia
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Drechsel KCE, Pilon MCF, Stoutjesdijk F, Meivis S, Schoonmade LJ, Wallace WHB, van Dulmen-den Broeder E, Beishuizen A, Kaspers GJL, Broer SL, Veening MA. Reproductive ability in survivors of childhood, adolescent, and young adult Hodgkin lymphoma: a review. Hum Reprod Update 2023:7034966. [PMID: 36779325 DOI: 10.1093/humupd/dmad002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Owing to a growing number of young and adolescent Hodgkin lymphoma (HL) survivors, awareness of (long-term) adverse effects of anticancer treatment increases. The risk of impaired reproductive ability is of great concern given its impact on quality of life. There is currently no review available on fertility after childhood HL treatment. OBJECTIVE AND RATIONALE The aim of this narrative review was to summarize existing literature on different aspects of reproductive function in male and female childhood, adolescent, and young adult HL survivors. SEARCH METHODS PubMed and EMBASE were searched for articles evaluating fertility in both male and female HL survivors aged <25 years at diagnosis. In females, anti-Müllerian hormone (AMH), antral follicle count, premature ovarian insufficiency (POI), acute ovarian failure, menstrual cycle, FSH, and pregnancy/live births were evaluated. In males, semen-analysis, serum FSH, inhibin B, LH, testosterone, and reports on pregnancy/live births were included. There was profound heterogeneity among studies and a lack of control groups; therefore, no meta-analyses could be performed. Results were presented descriptively and the quality of studies was not assessed individually. OUTCOMES After screening, 75 articles reporting on reproductive markers in childhood or adolescent HL survivors were included. Forty-one papers reported on 5057 female HL survivors. The incidence of POI was 6-34% (median 9%; seven studies). Signs of diminished ovarian reserve or impaired ovarian function were frequently seen (low AMH 55-59%; median 57%; two studies. elevated FSH 17-100%; median 53%; seven studies). Most survivors had regular menstrual cycles. Fifty-one studies assessed fertility in 1903 male HL survivors. Post-treatment azoospermia was highly prevalent (33-100%; median 75%; 29 studies). Long-term follow-up data were limited, but reports on recovery of semen up to 12 years post-treatment exist. FSH levels were often elevated with low inhibin B (elevated FSH 0-100%; median 51.5%; 26 studies. low inhibin B 19-50%; median 45%; three studies). LH and testosterone levels were less evidently affected (elevated LH 0-57%, median 17%; 21 studies and low testosterone 0-43%; median 6%; 15 studies). In both sexes, impaired reproductive ability was associated with a higher dose of cumulative chemotherapeutic agents and pelvic radiotherapy. The presence of abnormal markers before treatment indicated that the disease itself may also negatively affect reproductive function (Females: AMH<p10 9%; one study and Males: azoospermia 0-50%; median 10%; six studies). Reports on chance to achieve pregnancy during survivorship are reassuring, although studies had their limitations and the results are difficult to evaluate. In the end, a diminished ovarian reserve does not exclude the chance of a live birth, and males with aberrant markers may still be able to conceive. WIDER IMPLICATIONS This review substantiates the negative effect of HL treatment on gonadal function and therefore young HL survivors should be counseled regarding their future reproductive life, and fertility preservation should be considered. The current level of evidence is insufficient and additional trials on the effects of HL and (current) treatment regimens on reproductive function are needed. In this review, we make a recommendation on reproductive markers that could be assessed and the timing of (repeated) measurements.
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Affiliation(s)
- Katja C E Drechsel
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands
| | - Maxime C F Pilon
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Francis Stoutjesdijk
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Salena Meivis
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Eline van Dulmen-den Broeder
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Haematology/Oncology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Simone L Broer
- Department of Reproductive Medicine & Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margreet A Veening
- Pediatric Oncology, Cancer Center Amsterdam, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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4
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Repeated Low-Dose Acrolein Triggers Irreversible Lamina Propria Edema in Urinary Bladder, Transient Voiding Behavior and Widening of Eyes to Mechanical Stimuli. Cells 2021; 10:cells10123477. [PMID: 34943985 PMCID: PMC8700116 DOI: 10.3390/cells10123477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/23/2021] [Accepted: 12/04/2021] [Indexed: 12/04/2022] Open
Abstract
Acrolein is a metabolite of cyclophosphamide (CYP), an alkylating agent used for a wide range of benign and malignant diseases. CYP treatments are known to trigger hemorrhagic cystitis in patients and animals. Significant effort has been made to prevent CYP/acrolein-induced cystitis, while still maintaining its therapeutic benefits. As a result, supplementary therapeutic options to mediate the protective role against CYP/acrolein and lower doses of CYP are currently given to targeted patients, as compared to past treatments. There is still a need to further study the effects of the repeated low-dose CYP/acrolein on the pathophysiology of the urinary bladder. In our study, a one-time treatment of acrolein and repeated low-dose acrolein triggered the thickening of the smooth muscle and lamina propria in the urinary bladder of C57BL/6J mice, respectively. The first dose of acrolein did not trigger voiding dysfunction, but the second dose triggered high-volume low-frequency voiding. Interestingly, our new scoring criteria and concurrent behavioral assessment revealed that mice with repeated low-dose acrolein had a wider opening of eyes in response to mechanical stimuli. Our study suggests that clinical symptoms among patients undergoing prolonged low-dose CYP may differ from previously reported symptoms of CYP-induced hemorrhagic cystitis.
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Mulder RL, Font-Gonzalez A, Green DM, Loeffen EAH, Hudson MM, Loonen J, Yu R, Ginsberg JP, Mitchell RT, Byrne J, Skinner R, Anazodo A, Constine LS, de Vries A, Jahnukainen K, Lorenzo A, Meissner A, Nahata L, Dinkelman-Smit M, Tournaye H, Haupt R, van den Heuvel-Eibrink MM, van Santen HM, van Pelt AMM, Dirksen U, den Hartogh J, van Dulmen-den Broeder E, Wallace WH, Levine J, Tissing WJE, Kremer LCM, Kenney LB, van de Wetering MD. Fertility preservation for male patients with childhood, adolescent, and young adult cancer: recommendations from the PanCareLIFE Consortium and the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e57-e67. [PMID: 33539754 DOI: 10.1016/s1470-2045(20)30582-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Male patients with childhood, adolescent, and young adult cancer are at an increased risk for infertility if their treatment adversely affects reproductive organ function. Future fertility is a primary concern of patients and their families. Variations in clinical practice are barriers to the timely implementation of interventions that preserve fertility. As part of the PanCareLIFE Consortium, in collaboration with the International Late Effects of Childhood Cancer Guideline Harmonization Group, we reviewed the current literature and developed a clinical practice guideline for fertility preservation in male patients who are diagnosed with childhood, adolescent, and young adult cancer at age 25 years or younger, including guidance on risk assessment and available methods for fertility preservation. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to grade the available evidence and to form the recommendations. Recognising the need for global consensus, this clinical practice guideline used existing evidence and international expertise to rigorously develop transparent recommendations that are easy to use to facilitate the care of male patients with childhood, adolescent, and young adult cancer who are at high risk of fertility impairment and to enhance their quality of life.
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Affiliation(s)
- Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.
| | - Anna Font-Gonzalez
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Daniel M Green
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Erik A H Loeffen
- Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Melissa M Hudson
- Department of Epidemiology and Cancer Control and Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Richard Yu
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
| | - Jill P Ginsberg
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Rod T Mitchell
- Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Antoinette Anazodo
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia; Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Louis S Constine
- Department of Radiation Oncology and Department of Pediatrics, University of Rochester Medical Center, University of Rochester, NY, USA
| | - Andrica de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Kirsi Jahnukainen
- Children's Hospital, University of Helsinki, Helsinki, Finland; Helsinki University Central Hospital, Helsinki, Finland
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andreas Meissner
- Center for Reproductive Medicine, Amsterdam UMC, location AMC, Amsterdam, Netherlands; Department of Urology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Marij Dinkelman-Smit
- Division of Andrology, Department of Urology, Erasmus MC, Rotterdam, Netherlands
| | - Herman Tournaye
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and Livebirth Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Hematology and Oncology, Sophia Children's Hospital, Erasmus MC, Rotterdam, Netherlands
| | - Hanneke M van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, Netherlands
| | - Ans M M van Pelt
- Laboratory for Reproductive Biology, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Uta Dirksen
- Department of Pediatrics III, West German Cancer Centre, Essen University Hospital, Essen, Germany; German Cancer Consortium (DKTK) Partner Site, Essen, Germany
| | - Jaap den Hartogh
- Dutch Childhood Cancer Parent Organization (VOX), Nieuwegein, Netherlands
| | - Eline van Dulmen-den Broeder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - W Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jennifer Levine
- Division of Pediatric Hematology and Oncology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, UMC Groningen, University of Groningen, Groningen, Netherlands
| | - Leontien C M Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Pediatric Oncology, Emma Children's Hospital, Amsterdam University, Amsterdam UMC, location AMC, Amsterdam, Netherlands
| | - Lisa B Kenney
- Boston Children's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Harvard Universty, Boston, MA, USA
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van Santen HM, van de Wetering MD, Bos AME, Vd Heuvel-Eibrink MM, van der Pal HJ, Wallace WH. Reproductive Complications in Childhood Cancer Survivors. Pediatr Clin North Am 2020; 67:1187-1202. [PMID: 33131541 DOI: 10.1016/j.pcl.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gonadal dysfunction and infertility after cancer treatment are major concerns for childhood cancer survivors and their parents. Uncertainty about fertility or being diagnosed with infertility has a negative impact on quality of survival. In this article, determinants of gonadal damage are reviewed and consequences for fertility and pregnancies are discussed. Recommendations for screening and treatment of gonadal function are provided. These should enable timely treatment of gonadal insufficiency aiming to improve linear growth, pubertal development, and sexual functioning. Options for fertility preservation are discussed.
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Affiliation(s)
- Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, Utrecht 3505 AB, The Netherlands; Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands.
| | | | - Annelies M E Bos
- Department of Reproductive Medicine and Gynecology, University Medical Centre, Utrecht, Postbus 85500, Utrecht 3508 GA, the Netherlands
| | | | - Helena J van der Pal
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht 3584 CS, The Netherlands
| | - William Hamish Wallace
- Department of Pediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, Scotland
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7
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Can mesenchymal stem cells ameliorate testicular damage? Current researches. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.770063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Petrozzi A, Pallotti F, Pelloni M, Anzuini A, Radicioni AF, Lenzi A, Paoli D, Lombardo F. Inhibin B: are modified ranges needed for orchiectomised testicular cancer patients? Asian J Androl 2020; 21:332-336. [PMID: 30531061 PMCID: PMC6628744 DOI: 10.4103/aja.aja_93_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Inhibin B is a gonadal hormone that downregulates the pituitary production of follicle-stimulating hormone (FSH). In recent years, inhibin B has proved to be an excellent marker of spermatogenesis and even a predictive factor for the recovery of fertility in patients undergoing orchiectomy and antineoplastic treatments. We propose to study inhibin B levels in orchiectomised testicular cancer patients, in order to identify a minimum value representative of normal semen quality. This retrospective study evaluates hormonal and semen parameters of 290 normozoospermic patients attending the Laboratory of Seminology - Sperm Bank “Loredana Gandini” (Rome, Italy) for cryopreservation of seminal fluid following a diagnosis of testicular cancer (TC group) and 117 healthy, normozoospermic men as a control group (CTR group). The percentile distribution of gonadotropin and inhibin B values in the TC and CTR groups was analyzed. There was a statistically significant difference between the two groups in the levels of all hormones (P ≤ 0.001) and in all semen parameters (P < 0.05). About 20% of TC patients revealed inhibin B levels below the 5th percentile of CTR group, despite normozoospermia, and 31.4% had normal spermatogenesis in the presence of FSH values >95th percentile of CTR group. Orchiectomised patients for testicular cancer presented inhibin B levels lower than healthy patients, despite normozoospermia. Our study revealed the poor sensitivity of the current inhibin B reference range when applied to monorchidic patients, suggesting the need to establish more representative ranges to enable more appropriate counseling in relation to the patient's new endocrine condition.
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Affiliation(s)
- Alessandra Petrozzi
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Francesco Pallotti
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Marianna Pelloni
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Antonella Anzuini
- Hormone Laboratory, Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Antonio Francesco Radicioni
- Hormone Laboratory, Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Andrea Lenzi
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Donatella Paoli
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
| | - Francesco Lombardo
- Laboratory of Seminology, Sperm Bank "Loredana Gandini", Department of Experimental Medicine, Medical Pathophysiology Section, "Sapienza" University of Rome, Rome 00161, Italy
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9
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Anti-Müllerian hormone and Inhibin B after stem cell transplant in childhood: a comparison of myeloablative, reduced intensity and treosulfan-based chemotherapy regimens. Bone Marrow Transplant 2020; 55:1985-1995. [DOI: 10.1038/s41409-020-0866-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/20/2022]
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10
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Jahromi BN, Zeyghami S, Parsanezhad ME, Ghaemmaghami P, Zarei A, Kutenaee MA, Sohail P, Keshavarz P. Determining an optimal cut-off value for follicle-stimulating hormone to predict microsurgical testicular sperm extraction outcome in patients with non-obstructive azoospermia. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:165-170. [PMID: 32236315 PMCID: PMC10118940 DOI: 10.20945/2359-3997000000217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 07/03/2019] [Indexed: 11/23/2022]
Abstract
Objective To determine the optimal cut-off value for follicle stimulating hormone (FSH) to predict the outcome of microsurgical testicular sperm extraction (micro-TESE) in patients with nonobstructive azoospermia (NOA). Subjects and methods We included a total number of 180 patients with NOA. The serum level of FSH was determined and all the subjects underwent micro-TESE. We determined the optimal cut-off value for FSH and assessed whether the test could be effectively used as a successful predictor of sperm retrieval by calculating the Receiver Operating Characteristic (ROC) area under the curve. Results Overall we included a total number of 171 patients with mean age of 34.3 ± 8.6 years. The micro-TESE was considered to be successful in 79 (43.8%) while it failed in 92 (56.2%) patients. We found that the mean level of serum FSH was significantly higher in group those with failed micro-TEST compared to successful group (p < 0.001). The cut-off value for FSH was calculated to be 14.6 mIU/mL to predictive the outcome of micro-TESE with a sensitivity of 83.5% [73.5%-90.9%] and a specificity of 80.3% [69.5%-88.5%]. At this value, the other parameters were calculated to be PPV, 81.5%; NPV, 82.4; LR+, 4.23; and LR-, 0.21. Conclusions The results of the current study indicate that FSH plasma levels above 14.6 mIU/mL can be considered to be the failure predictor of the micro-TESE in NOA patients.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center, Department of OB-GYN, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahryar Zeyghami
- Ghadir madar Hospital, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ebrahim Parsanezhad
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvin Ghaemmaghami
- Departments of biostatistics, medical school, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afsoon Zarei
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Azizi Kutenaee
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parastoo Sohail
- Ghadir madar Hospital, Hormozgan Fertility and Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pedram Keshavarz
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Moraveji SF, Esfandiari F, Taleahmad S, Nikeghbalian S, Sayahpour FA, Masoudi NS, Shahverdi A, Baharvand H. Suppression of transforming growth factor-beta signaling enhances spermatogonial proliferation and spermatogenesis recovery following chemotherapy. Hum Reprod 2019; 34:2430-2442. [DOI: 10.1093/humrep/dez196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Could small molecules (SM) which target (or modify) signaling pathways lead to increased proliferation of undifferentiated spermatogonia following chemotherapy?
SUMMARY ANSWER
Inhibition of transforming growth factor-beta (TGFb) signaling by SM can enhance the proliferation of undifferentiated spermatogonia and spermatogenesis recovery following chemotherapy.
WHAT IS KNOWN ALREADY
Spermatogonial stem cells (SSCs) hold great promise for fertility preservation in prepubertal boys diagnosed with cancer. However, the low number of SSCs limits their clinical applications. SM are chemically synthesized molecules that diffuse across the cell membrane to specifically target proteins involved in signaling pathways, and studies have reported their ability to increase the proliferation or differentiation of germ cells.
STUDY DESIGN, SIZE, DURATION
In our experimental study, spermatogonia were collected from four brain-dead individuals and used for SM screening in vitro. For in vivo assessments, busulfan-treated mice were treated with the selected SM (or vehicle, the control) and assayed after 2 (three mice per group) and 5 weeks (two mice per group).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We investigated the effect of six SM on the proliferation of human undifferentiated spermatogonia in vitro using a top–bottom approach for screening. We used histological, hormonal and gene-expression analyses to assess the effect of selected SM on mouse spermatogenesis. All experiments were performed at least in triplicate and were statistically evaluated by Student’s t-test and/or one-way ANOVA followed by Scheffe’s or Tukey’s post-hoc.
MAIN RESULTS AND THE ROLE OF CHANCE
We found that administration of SB431542, as a specific inhibitor of the TGFb1 receptor (TGFbR1), leads to a two-fold increase in mouse and human undifferentiated spermatogonia proliferation. Furthermore, injection of SB to busulfan-treated mice accelerated spermatogenesis recovery as revealed by increased testicular size, weight and serum level of inhibin B. Moreover, SB administration accelerated both the onset and completion of spermatogenesis. We demonstrated that SB promotes proliferation in testicular tissue by regulating the cyclin-dependent kinase (CDK) inhibitors 4Ebp1 and P57 (proliferation inhibitor genes) and up-regulating Cdc25a and Cdk4 (cell cycle promoting genes).
LIMITATIONS, REASONS FOR CAUTION
The availability of human testis was the main limitation in this study.
WIDER IMPLICATIONS OF THE FINDINGS
This is the first study to report acceleration of spermatogenesis recovery following chemotherapy by administration of a single SM. Our findings suggest that SB is a promising SM and should be assessed in future clinical trials for preservation of fertility in men diagnosed with cancer or in certain infertility cases (e.g. oligospermia).
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by Royan Institute and National Institute for Medical Research Development (NIMAD, grant no 963337) granted to H.B. The authors have no conflict of interest to report.
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Affiliation(s)
- Seyedeh-Faezeh Moraveji
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Fereshteh Esfandiari
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sara Taleahmad
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Forough-Azam Sayahpour
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Najmeh-Sadat Masoudi
- Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Abdolhossein Shahverdi
- Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hossein Baharvand
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Developmental Biology, University of Science and Culture, Tehran, Iran
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12
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Duca Y, Di Cataldo A, Russo G, Cannata E, Burgio G, Compagnone M, Alamo A, Condorelli RA, La Vignera S, Calogero AE. Testicular Function of Childhood Cancer Survivors: Who Is Worse? J Clin Med 2019; 8:jcm8122204. [PMID: 31847212 PMCID: PMC6947348 DOI: 10.3390/jcm8122204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/07/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022] Open
Abstract
Background: A multi-disciplinary approach has led to an improvement in prognosis of childhood cancers. However, in parallel with the increase in survival rate, there is a greater occurrence of long-term toxicity related to antineoplastic treatment. Hypogonadism and infertility are among the most frequent endocrinological sequelae in young adult childhood cancer survivors. The aim of this study was to identify which category of patients, grouped according to diagnosis, therapy, and age at treatment, shows the worst reproductive function in adulthood. Methods: We evaluated morpho-volumetric development of the testis, endocrine function of the hypothalamic–pituitary–gonadal axis, and sperm parameters in 102 young adult childhood cancer survivors. Results: Overall, about one-third of patients showed low total testicular volume, total testosterone (TT) <3.5 ng/mL, and altered sperm count. Hodgkin’s disease, hematopoietic stem cell transplantation, and non-cranial irradiation associated to chemotherapy were risk factors for poor gonadal function. Patients treated in pubertal age showed lower total testicular volume; however, the difference was due to more gonadotoxic treatment performed in older age. Testicular volume was more predictive of spermatogenesis than follicle-stimulating hormone (FSH), while anti-Müllerian hormone (AMH) was not useful in the evaluation of testicular function of male childhood cancer survivors. Conclusions: Pre-pubertal subjects at high risk of future infertility should be candidates for testicular tissue cryopreservation.
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Affiliation(s)
- Ylenia Duca
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
| | - Andrea Di Cataldo
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.D.C.); (G.R.); (E.C.)
| | - Giovanna Russo
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.D.C.); (G.R.); (E.C.)
| | - Emanuela Cannata
- Pediatric Oncohematology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (A.D.C.); (G.R.); (E.C.)
| | - Giovanni Burgio
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
| | - Michele Compagnone
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
| | - Angela Alamo
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
| | - Rosita A. Condorelli
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
| | - Sandro La Vignera
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
- Correspondence: ; Tel.: +39-095-378-1435
| | - Aldo E. Calogero
- Andrology and Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (Y.D.); (G.B.); (M.C.); (A.A.); (R.A.C.); (A.E.C.)
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13
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Grinspon RP, Arozarena M, Prada S, Bargman G, Sanzone M, Morales Bazurto M, Gutiérrez M, Bedecarrás P, Kannemann A, Elena GO, Gottlieb S, Berenstein AJ, Ropelato MG, Bergadá I, Aversa LA, Rey RA. Safety of standardised treatments for haematologic malignancies as regards to testicular endocrine function in children and teenagers. Hum Reprod 2019; 34:2480-2494. [PMID: 31768530 DOI: 10.1093/humrep/dez216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/02/2019] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION Does standardised treatments used in children and adolescents with haematologic malignancies, including acute lymphoblastic (ALL) or myeloid leukaemia (AML) and non-Hodgkin lymphoma (NHL), affect endocrine function of the developing testes? SUMMARY ANSWER Therapy of haematologic malignancies do not provoke an overt damage of Sertoli and Leydig cell populations, as revealed by normal levels of anti-Müllerian hormone (AMH) and testosterone, but a mild primary testicular dysfunction may be observed, compensated by moderate gonadotropin elevation, during pubertal development. WHAT IS KNOWN ALREADY Evidence exists on the deleterious effect that chemotherapy and radiotherapy have on germ cells, and some attention has been given to the effects on Leydig and Sertoli cells of the adult gonads, but information is virtually non-existent on the effects of oncologic treatment on testicular somatic cell components during childhood and adolescence. STUDY DESIGN, SIZE, DURATION A retrospective, analytical, observational study included 97 boys with haematological malignancies followed at two tertiary paediatric public hospitals in Buenos Aires, Argentina, between 2002 and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical records of males aged 1-18 years, referred with the diagnoses of ALL, AML or NHL for the assessment of gonadal function, were eligible. We assessed serum levels of AMH and FSH as biomarkers of Sertoli cell endocrine function and testosterone and LH as biomarkers of Leydig cell function. MAIN RESULTS AND THE ROLE OF CHANCE All hormone levels were normal in the large majority of patients until early pubertal development. From Tanner stage G3 onwards, while serum AMH and testosterone kept within the normal ranges, gonadotropins reached mildly to moderately elevated values in up to 35.9% of the cases, indicating a compensated Sertoli and/or Leydig cell dysfunction, which generally did not require hormone replacement therapy. LIMITATIONS, REASONS FOR CAUTION Serum inhibin B determination and semen analysis were not available for most patients; therefore, we could not conclude on potential fertility impairment or identify whether primary Sertoli cell dysfunction resulted in secondary depleted spermatogenesis or whether primary germ cell damage impacted Sertoli cell function. WIDER IMPLICATIONS OF THE FINDINGS The regimens used in the treatment of boys and adolescents with ALL, AML or NHL in the past two decades seem relatively safe for endocrine testicular function; nonetheless, a mild primary testicular endocrine dysfunction may be observed, usually compensated by slightly elevated gonadotropin secretion by the pituitary in adolescents, and not requiring hormone replacement therapy. No clinically relevant risk factor, such as severity of the disease or treatment protocol, could be identified in association with the compensated endocrine dysfunction. STUDY FUNDING/COMPETING INTEREST(S) This work was partially funded by grants PIP 11220130100687 of Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) and PICT 2016-0993 of Fondo para la Investigación Científica y Tecnológica (FONCYT), Argentina. R.A.R., R.P.G. and P.B. have received honoraria from CONICET (Argentina) for technology services using the AMH ELISA. L.A.A. is part-time employee of CSL Behring Argentina. The other authors have no conflicts of interest to disclose.
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Affiliation(s)
- Romina P Grinspon
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - María Arozarena
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Silvina Prada
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Graciela Bargman
- División de Endocrinología, Hospital de Niños Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - María Sanzone
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Marjorie Morales Bazurto
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Marcela Gutiérrez
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Patricia Bedecarrás
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ana Kannemann
- Unidad de Hematología, Hospital Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - Graciela O Elena
- Unidad de Hematología, Hospital Pedro de Elizalde, C1270AAN Buenos Aires, Argentina
| | - Silvia Gottlieb
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ariel J Berenstein
- Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas (IMIPP), CONICET-GCBA, Laboratorio de Biología Molecular, División Patología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - María Gabriela Ropelato
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Luis A Aversa
- Unidad de Hematología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
| | - Rodolfo A Rey
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, C1425EFD Buenos Aires, Argentina
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14
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Wei C, Crowne E. The impact of childhood cancer and its treatment on puberty and subsequent hypothalamic pituitary and gonadal function, in both boys and girls. Best Pract Res Clin Endocrinol Metab 2019; 33:101291. [PMID: 31327697 DOI: 10.1016/j.beem.2019.101291] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Childhood cancer survivors (CCS) are at an increased risk of endocrine disorders. Disorders of the hypothalamic-pituitary-gonadal (HPG) axis are a particular concern because of their impact on pubertal development and future fertility and may be of central (hypothalamic or pituitary damage) or primary (gonadal) origin. Hypogonadism may present as pubertal disorders during adolescence and subsequent infertility in adulthood but should be anticipated to ensure appropriate surveillance is in place to address these issues at an appropriate age. Those at risk of HPG axis dysfunction include those with tumours primarily affecting the hypothalamus, pituitary or gonads themselves or due to their treatment with surgery, radiotherapy and chemotherapy. CCS who have had cranial irradiation of more than 30 Gy are at risk of gonadotrophin deficiency. Those who have had gonadotoxic chemotherapy, especially alkylating agents or radiotherapy to the gonads are at risk of primary gonadal failure. HSCT survivors who have had chemotherapy and total body irradiation are at risk of primary gonadal failure but may also have gonadotrophin deficiency. Understanding those at risk is essential to appropriate counselling and long-term follow-up. This chapter gives an overview on the impact of childhood cancer and its treatment on puberty, gonadal function and fertility in childhood cancer survivors.
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Affiliation(s)
- Christina Wei
- St George's University Hospital, NHS Foundation Trust, London, UK
| | - Elizabeth Crowne
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
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15
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van Santen HM, van den Heuvel-Eibrink MM, van de Wetering MD, Wallace WH. Hypogonadism in Children with a Previous History of Cancer: Endocrine Management and Follow-Up. Horm Res Paediatr 2019; 91:93-103. [PMID: 30703774 PMCID: PMC6615280 DOI: 10.1159/000495943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/29/2018] [Indexed: 01/15/2023] Open
Abstract
Hypogonadism after treatment for childhood cancer is a recognized complication and its cause may be subdivided into primary gonadal failure and central hypogonadism. Here, we provide an overview of the risk factors for the development of hypogonadism, assessment and potential interventions and give a summary of the current recommendations for management and follow-up of hypogonadism in childhood cancer survivors.
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Affiliation(s)
- Hanneke M. van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, Utrecht, The Netherlands,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands,*Hanneke M. van Santen, Pediatric Endocrinology, Wilhelmina Children's Hospital, UMCU, PO Box 85090, NL–3505 AB Utrecht (The Netherlands), E-Mail
| | | | | | - W. Hamish Wallace
- Department of Paediatric Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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16
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Shahriari M, Ghasemi K, Bordbar M, Shakibazad N. Gynecomastia as a late complication of childhood cancer and its treatment that can affect the quality of life of male survivors. Semin Oncol 2019; 46:155-159. [PMID: 31128839 DOI: 10.1053/j.seminoncol.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/07/2019] [Accepted: 04/24/2019] [Indexed: 11/11/2022]
Abstract
Childhood cancer is relatively rare, and nowadays it is curable in more than 80% of children. Childhood cancer therapy is directed not only at improving survival but recently, we also concentrate on reducing late effects. We want children who have a diagnosis of cancer to survive and have an excellent quality of life. Gynecomastia and fertility outcome of the survivors of childhood malignancies should be considered in the follow-up of teen agers and young adults and should be approached in an accurate manner and managed in comprehensive teams.
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Affiliation(s)
- Mahdi Shahriari
- Division of Pediatric Hematology and Oncology, Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadijeh Ghasemi
- Department of Pediatric Nephrology, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | - Nader Shakibazad
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Pediatric Hematology and Oncology, Bushehr University of Medical Sciences, Bushehr, Iran.
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17
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van der Kooi ALLF, van den Heuvel-Eibrink MM, van den Berg SAA, van Dorp W, Pluijm SMF, Laven JSE. Changes in Anti-Müllerian Hormone and Inhibin B in Children Treated for Cancer. J Adolesc Young Adult Oncol 2019; 8:281-290. [PMID: 30702361 DOI: 10.1089/jayao.2018.0130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Diminished reproductive function can be a major late effect of childhood cancer treatment. This study evaluates the changes, and occurrence of possible recovery, in gonadal function markers in children treated for cancer. Methods: Gonadal function markers were measured before (T0), directly after (T1), and 1 year after (T2) end of treatment of childhood cancer. Anti-Müllerian hormone (AMH) was measured in girls and inhibin B in boys and compared to reference populations. Repeated measures analysis of variance and t-tests were employed for data analysis. Results: Baseline gonadal function markers (T0) at diagnosis were available in 129 girls and 150 boys. Paired gonadal function markers were available in 49 girls and 54 boys for T0-T1, and in 27 girls and 32 boys for T1-T2. Gonadal function markers were significantly lower than the reference population at each time point (p < 0.001). Post-menarcheal girls showed a decrease in AMH between T0 and T1 (standard deviation scores [SDS] -0.72 to -1.32, p = 0.007), and in the boys cohort, a decrease in inhibin B (SDS -1.14 to -1.43, p = 0.045) was observed. Impaired gonadal function levels (<5th percentile) at T1 were observed in 15 of 27 (56%) girls and in 15 of 32 (47%) boys. However, gonadal function had recovered at T2 in seven girls and six boys. Conclusion: Our data suggest that gonadal function is already compromised at diagnosis and is further decreased by childhood cancer treatment. Nevertheless, about half of the children with gonadal impairment recovered over time. Evaluation of gonadal function markers before 1 year after end of treatment may therefore be unreliable.
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Affiliation(s)
- Anne-Lotte L F van der Kooi
- 1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,2 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Sjoerd A A van den Berg
- 3 Department of Clinical Chemistry, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wendy van Dorp
- 1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Saskia M F Pluijm
- 2 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Joop S E Laven
- 1 Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Kenney LB, Antal Z, Ginsberg JP, Hoppe BS, Bober SL, Yu RN, Constine LS, van Santen HM, Skinner R, Green DM. Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research. J Clin Oncol 2018; 36:2160-2168. [PMID: 29874140 DOI: 10.1200/jco.2017.76.3839] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.
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Affiliation(s)
- Lisa B Kenney
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Zoltan Antal
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Jill P Ginsberg
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Bradford S Hoppe
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Sharon L Bober
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Richard N Yu
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Louis S Constine
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Hanneke M van Santen
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Roderick Skinner
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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Nikpour F, Tayefi H, Mohammadnejad D, Akbarzadeh A. Adverse Effects of Vincristine Chemotherapy on Cell Changes in Seminiferous Tubules and Cetrorelix GnRH Antagonist
Inhibitory Effects in Mice. Asian Pac J Cancer Prev 2018; 19:683-687. [PMID: 29580040 PMCID: PMC5980841 DOI: 10.22034/apjcp.2018.19.3.683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The present study was designed to determine changes in spermatogenesis in adult mice after an intraperitoneal injection of vincristine. The effect of a GnRH antagonist synchronous to chemotherapy, which might protect spermatogenesis by halting cell division in spermatogenic cells, was also investigated.
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Affiliation(s)
- Fatemeh Nikpour
- Department of Histological Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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Casano Sancho P. Endocrine sequelae in childhood cancer survivors. ENDOCRINOLOGÍA, DIABETES Y NUTRICIÓN (ENGLISH ED.) 2017. [DOI: 10.1016/j.endien.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Endocrine sequelae in childhood cancer survivors. ACTA ACUST UNITED AC 2017; 64:498-505. [PMID: 29050706 DOI: 10.1016/j.endinu.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
Abstract
Thanks to the advances in cancer treatment, the five-year survival rate after childhood cancer has increased up to 80%. Therefore 1/500 young adults will be a survivor. Endocrine sequelae are most common, affecting 40-60% of survivors. The most frequent sequelae include growth failure and gonadal and thyroid diseases. Sequelae occur more frequently in survivors from central nervous system tumors, leukemia, and lymphoma. Their development will depend on the type of cancer, its location, age at diagnosis, and treatment administered. Treatments associated to more endocrine sequels are cranial radiotherapy and hematopoietic cell transplantation. Because of the high prevalence of endocrine sequelae, international guidelines recommend endocrinologists to prospectively evaluate the survivors. As some of these endocrine changes will not develop until adult life, transition programs should be implemented, and active investigation should be made to decrease the endocrine consequences of cancer treatment.
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Kelsey TW, McConville L, Edgar AB, Ungurianu AI, Mitchell RT, Anderson RA, Wallace WHB. Follicle Stimulating Hormone is an accurate predictor of azoospermia in childhood cancer survivors. PLoS One 2017; 12:e0181377. [PMID: 28727831 PMCID: PMC5519149 DOI: 10.1371/journal.pone.0181377] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
The accuracy of Follicle Stimulating Hormone as a predictor of azoospermia in adult survivors of childhood cancer is unclear, with conflicting results in the published literature. A systematic review and post hoc analysis of combined data (n = 367) were performed on all published studies containing extractable data on both serum Follicle Stimulating Hormone concentration and semen concentration in survivors of childhood cancer. PubMed and Medline databases were searched up to March 2017 by two blind investigators. Articles were included if they contained both serum FSH concentration and semen concentration, used World Health Organisation certified methods for semen analysis, and the study participants were all childhood cancer survivors. There was no evidence for either publication bias or heterogeneity for the five studies. For the combined data (n = 367) the optimal Follicle Stimulating Hormone threshold was 10.4 IU/L with specificity 81% (95% CI 76%–86%) and sensitivity 83% (95% CI 76%–89%). The AUC was 0.89 (95%CI 0.86–0.93). A range of threshold FSH values for the diagnosis of azoospermia with their associated sensitivities and specificities were calculated. This study provides strong supporting evidence for the use of serum Follicle Stimulating Hormone as a surrogate biomarker for azoospermia in adult males who have been treated for childhood cancer.
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Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom
| | - Lauren McConville
- School of Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Angela B. Edgar
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Alex I. Ungurianu
- School of Computer Science, University of St. Andrews, St. Andrews, United Kingdom
| | - Rod T. Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - W. Hamish B. Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
- * E-mail:
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Skinner R, Mulder RL, Kremer LC, Hudson MM, Constine LS, Bardi E, Boekhout A, Borgmann-Staudt A, Brown MC, Cohn R, Dirksen U, Giwercman A, Ishiguro H, Jahnukainen K, Kenney LB, Loonen JJ, Meacham L, Neggers S, Nussey S, Petersen C, Shnorhavorian M, van den Heuvel-Eibrink MM, van Santen HM, Wallace WHB, Green DM. Recommendations for gonadotoxicity surveillance in male childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. Lancet Oncol 2017; 18:e75-e90. [PMID: 28214419 DOI: 10.1016/s1470-2045(17)30026-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/04/2016] [Accepted: 10/17/2016] [Indexed: 11/28/2022]
Abstract
Treatment with chemotherapy, radiotherapy, or surgery that involves reproductive organs can cause impaired spermatogenesis, testosterone deficiency, and physical sexual dysfunction in male pubertal, adolescent, and young adult cancer survivors. Guidelines for surveillance and management of potential adverse effects could improve cancer survivors' health and quality of life. Surveillance recommendations vary considerably, causing uncertainty about optimum screening practices. This clinical practice guideline recommended by the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium, developed using evidence-based methodology, critically synthesises surveillance recommendations for gonadotoxicity in male childhood, adolescent, and young adult (CAYA) cancer survivors. The recommendations were developed by an international multidisciplinary panel including 25 experts in relevant medical specialties, using a consistent and transparent process. Recommendations were graded according to the strength of underlying evidence and potential benefit gained by early detection and appropriate management. The aim of the recommendations is to enhance evidence-based care for male CAYA cancer survivors. The guidelines reveal the paucity of high-quality evidence, highlighting the need for further targeted research.
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Affiliation(s)
- Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology and Children's Haemopoietic Stem Cell Transplant Unit, Great North Children's Hospital and Northern Institute of Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
| | - Renee L Mulder
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Louis S Constine
- Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Edit Bardi
- 2nd Department of Pediatrics, Semmeilweis University, Budapest, Hungary; Hungary and Johannes Kepler Universitätsklinikum, Linz, Austria
| | - Annelies Boekhout
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Anja Borgmann-Staudt
- Department of Paediatric Haematology, Oncology and Haemopoietic Stem Cell Transplantation, Charité-Universitätsmedizin, Berlin, Germany
| | - Morven C Brown
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Cohn
- Kids Cancer Centre, Sydney Children's Hospital, Sydney and UNSW Medicine, Sydney, NSW, Australia
| | - Uta Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Muenster, Muenster, Germany
| | | | - Hiroyuki Ishiguro
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Kirsi Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lisa B Kenney
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Harvard Medical School, Boston, MA, USA
| | - Jacqueline J Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lilian Meacham
- Department of Pediatrics, Division of Hematology/Oncology and Endocrinology, Emory University and Aflac Cancer Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sebastian Neggers
- Department of Medicine section Endocrinology, Erasmus University Medical Center Rotterdam and Pediatric Oncology, Sophia's Children's Hospital/Erasmus University Medical Center, Rotterdam, Netherlands
| | - Stephen Nussey
- Department of Endocrinology, St George's University of London, London, UK
| | - Cecilia Petersen
- Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Margarett Shnorhavorian
- Department of Urology, University of Washington, Division of Pediatric Urology, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Kinderziekenhuis, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | | | - Daniel M Green
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
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Wigny KM, van Dorp W, van der Kooi ALL, de Rijke YB, de Vries AC, Smit M, Pluijm SM, van den Akker EL, Pieters R, Laven JS, van den Heuvel-Eibrink MM. Gonadal function in boys with newly diagnosed cancer before the start of treatment. Hum Reprod 2016; 31:2613-2618. [DOI: 10.1093/humrep/dew234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/12/2016] [Accepted: 07/15/2016] [Indexed: 11/12/2022] Open
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Kelsey TW, Miles A, Mitchell RT, Anderson RA, Wallace WHB. A Normative Model of Serum Inhibin B in Young Males. PLoS One 2016; 11:e0153843. [PMID: 27077369 PMCID: PMC4831823 DOI: 10.1371/journal.pone.0153843] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/05/2016] [Indexed: 11/18/2022] Open
Abstract
Inhibin B has been identified as a potential marker of Sertoli cell function in males. The aim of this study is to produce a normative model of serum inhibin B in males from birth to seventeen years. We used a well-defined search strategy to identify studies containing data that can contribute to a larger approximation of the healthy population. We combined data from four published studies (n = 709) and derived an internally validated model with high goodness-of-fit and normally distributed residuals. Our results show that inhibin B increases following birth to a post-natal peak of 270 pg/mL (IQR 210-335 pg/mL) and then decreases during childhood followed by a rise at around 8 years, peaking at a mean 305 pg/mL (IQR 240-445 pg/mL) at around age 17. Following this peak there is a slow decline to the standard mature adult normal range of 170 pg/mL (IQR 125-215 pg/mL). This normative model suggests that 35% of the variation in Inhibin B levels in young males is due to age alone, provides an age-specific reference range for inhibin B in the young healthy male population, and will be a powerful tool in evaluating the potential of inhibin B as a marker of Sertoli cell function in pre-pubertal boys.
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Affiliation(s)
- Thomas W. Kelsey
- School of Computer Science, University of St Andrews, St Andrews KY16 9SX, United Kingdom
| | - Amy Miles
- School of Medicine, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Rod T. Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - W. Hamish B. Wallace
- Department of Haematology/Oncology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
- * E-mail:
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Makey CM, McClean MD, Braverman LE, Pearce EN, Sjödin A, Weinberg J, Webster TF. Polybrominated diphenyl ether exposure and reproductive hormones in North American men. Reprod Toxicol 2016; 62:46-52. [PMID: 27094376 DOI: 10.1016/j.reprotox.2016.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 03/16/2016] [Accepted: 04/07/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Polybrominated diphenyl ethers (PBDEs) are flame retardant chemicals that are persistent organic pollutants. Animal experiments and some human studies indicate that PBDEs may adversely affect male reproductive function. OBJECTIVES To assess the association between PBDE exposure and reproductive hormones (RHs) in a North American male adult cohort. METHODS From 2010-11, we collected three serum samples from 27 healthy adult men. We assessed associations between PBDEs and RHs using mixed effect regression models. RESULTS PBDEs were inversely associated with inhibin-B. In older men, increased concentrations of BDE-47 and BDE-100 were significantly associated with a decrease in inhibin-B, and an increase in follicular stimulating hormone (FSH). CONCLUSIONS These findings suggest PBDE exposure may affect RHs in older men. We did not measure other parameters of male reproductive function and therefore these results are preliminary.
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Affiliation(s)
- Colleen M Makey
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
| | - Michael D McClean
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
| | - Lewis E Braverman
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 72 E. Concord Street, Boston, MA 02118, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, 72 E. Concord Street, Boston, MA 02118, USA
| | - Andreas Sjödin
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Janice Weinberg
- Department of Biostatistics, Boston University School of Public Health, 1010 Massachusetts Ave, Boston, MA 02118, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
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28
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Anderson RA, Mitchell RT, Kelsey TW, Spears N, Telfer EE, Wallace WHB. Cancer treatment and gonadal function: experimental and established strategies for fertility preservation in children and young adults. Lancet Diabetes Endocrinol 2015; 3:556-67. [PMID: 25873571 DOI: 10.1016/s2213-8587(15)00039-x] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Preservation of gonadal function is an important priority for the long-term health of cancer survivors of both sexes and all ages at treatment. Loss of opportunity for fertility is a prime concern in both male and female cancer survivors, but endocrine effects of gonadal damage are likewise central to long-term health and wellbeing. Some fertility preservation techniques, such as semen and embryo cryopreservation, are established and successful in adults, and development of oocyte vitrification has greatly improved the potential to cryopreserve unfertilised oocytes. Despite being recommended for all pubertal male patients, sperm banking is not universally practised in paediatric oncology centres, and very few adolescent-friendly facilities exist. All approaches to fertility preservation have specific challenges in children and teenagers, including ethical, practical, and scientific issues. For young women, cryopreservation of ovarian cortical tissue with later replacement has resulted in at least 40 livebirths, but is still regarded as experimental in most countries. For prepubertal boys, testicular biopsy cryopreservation is offered in some centres, but how that tissue might be used in the future is unclear, and so far no evidence suggests that fertility can be restored. For both sexes, these approaches involve an invasive procedure and have an uncertain risk of tissue contamination in haematological and other malignancies. Decision making for all these approaches needs assessment of the individual's risk of fertility loss, and is made at a time of emotional distress. Development of this specialty needs better provision of information for patients and their medical teams, and improvements in service provision, to match technical and scientific advances.
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Affiliation(s)
- Richard A Anderson
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas W Kelsey
- School of Computer Science, University of St Andrews, St Andrews, UK
| | - Norah Spears
- Centre for Integrative Physiology, Hugh Robson Building, University of Edinburgh, Edinburgh, UK
| | - Evelyn E Telfer
- Centre for Integrative Physiology, Hugh Robson Building, University of Edinburgh, Edinburgh, UK
| | - W Hamish B Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
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Jahnukainen K, Mitchell RT, Stukenborg JB. Testicular function and fertility preservation after treatment for haematological cancer. Curr Opin Endocrinol Diabetes Obes 2015; 22:217-23. [PMID: 25871959 DOI: 10.1097/med.0000000000000156] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Treatment for high-risk or relapsed haematological malignancy with haematopoietic stem cell transplantation is known to cause infertility. Today, there are no established options for fertility preservation in pre-pubertal boys. This review aims to describe how therapy for haematological malignancy in childhood affects male fertility, and to summarize recent developments for fertility preservation in these patients. RECENT FINDINGS Eventual recovery of spermatogenesis is probable after chemotherapy-based conditioning for haematopoietic stem cell transplantation. However, conditioning with total body irradiation is associated with a very high risk of permanent infertility. For high-risk patients, auto-transplantation of cryopreserved testicular tissue or cells might represent an approach for fertility preservation; however, contamination of testis tissue with malignant cells may prevent their subsequent reintroduction into patients. Recent progress using in-vitro differentiation of germ cells combined with assisted reproductive techniques may, in the future, represent a suitable alternative to retransplantation. SUMMARY Particular care must be taken when assessing infertility risk in patients with haematological malignancy as reclassification to high risk may significantly increase the likelihood of treatment-related gonadotoxicity. Importantly, development of fertility preservation strategies in such high-risk patients must also take into account specific risks for haematological cancers including cancer cell contamination.
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Affiliation(s)
- Kirsi Jahnukainen
- aPediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden bDivision of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland cMRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh dThe Edinburgh Royal Hospital for Sick Children, Edinburgh, UK *Kirsi Jahnukainen, Rod T. Mitchell, and Jan-Bernd Stukenborg contributed equally to the writing of this aticle
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Harrison DJ, Schwartz C. Survivorship. J Surg Oncol 2014; 111:648-55. [PMID: 25557722 DOI: 10.1002/jso.23844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/13/2014] [Indexed: 01/04/2023]
Abstract
Significant therapeutic advances for soft tissue sarcomas allow increasing numbers of patients--adult and pediatric--to achieve long term survival. However, the harsh cytotoxic therapies are responsible for adverse physical and psychosocial effects that require long-term follow-up care, specific to survivorship issues. In the adult and pediatric patient population, guidelines for care developed by experts in comprehensive survivorship clinics are evolving to assist the practitioner while on-line supports bring information directly to the survivors.
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De Pinho JC, Sauer MV. Infertility and ART after transplantation. Best Pract Res Clin Obstet Gynaecol 2014; 28:1235-50. [DOI: 10.1016/j.bpobgyn.2014.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/27/2022]
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Makanji Y, Zhu J, Mishra R, Holmquist C, Wong WPS, Schwartz NB, Mayo KE, Woodruff TK. Inhibin at 90: from discovery to clinical application, a historical review. Endocr Rev 2014; 35:747-94. [PMID: 25051334 PMCID: PMC4167436 DOI: 10.1210/er.2014-1003] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
When it was initially discovered in 1923, inhibin was characterized as a hypophysiotropic hormone that acts on pituitary cells to regulate pituitary hormone secretion. Ninety years later, what we know about inhibin stretches far beyond its well-established capacity to inhibit activin signaling and suppress pituitary FSH production. Inhibin is one of the major reproductive hormones involved in the regulation of folliculogenesis and steroidogenesis. Although the physiological role of inhibin as an activin antagonist in other organ systems is not as well defined as it is in the pituitary-gonadal axis, inhibin also modulates biological processes in other organs through paracrine, autocrine, and/or endocrine mechanisms. Inhibin and components of its signaling pathway are expressed in many organs. Diagnostically, inhibin is used for prenatal screening of Down syndrome as part of the quadruple test and as a biochemical marker in the assessment of ovarian reserve. In this review, we provide a comprehensive summary of our current understanding of the biological role of inhibin, its relationship with activin, its signaling mechanisms, and its potential value as a diagnostic marker for reproductive function and pregnancy-associated conditions.
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Affiliation(s)
- Yogeshwar Makanji
- Department of Obstetrics and Gynecology (Y.M., J.Z., C.H., W.P.S.W., T.K.W.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60610; Center for Molecular Innovation and Drug Discovery (R.M., C.H.), Chemistry of Life Processes Institute, Northwestern University, Evanston, Illinois 60208; and Department of Molecular Biosciences (N.B.S., K.E.M., T.K.W.), Center for Reproductive Science, Northwestern University, Evanston, Illinois 60208
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Blijdorp K, van Dorp W, Laven JSE, Pieters R, de Jong FH, Pluijm SMF, van der Lely AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Obesity independently influences gonadal function in very long-term adult male survivors of childhood cancer. Obesity (Silver Spring) 2014; 22:1896-903. [PMID: 24753296 DOI: 10.1002/oby.20766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/04/2014] [Accepted: 04/06/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although obesity is associated with gonadal dysfunction in the general population, gonadotoxic treatment might diminish the impact of obesity in childhood cancer survivors (CCS). The aim was to evaluate whether altered body composition is associated with gonadal dysfunction in male CCS, independent of gonadotoxic cancer treatment. METHODS Three hundred fifty-one male CCS were included. Median age at diagnosis was 5.9 years (0-17.8) and median age at follow-up 25.6 years (18.0-45.8). Total and non-SHBG-bound testosterone, sex hormone-binding globulin, inhibin B, and follicle-stimulating hormone (FSH) were studied. Potential determinants were BMI, waist circumference, waist-hip ratio, and body composition measures (dual energy X-ray absorptiometry). RESULTS Non-SHBG-bound testosterone was significantly decreased in survivors with BMI ≥ 30 kg/m(2) (adjusted mean 9.1 nmol/L vs. 10.2 nmol/L, P = 0.015), high fat percentage (10.0 vs. 11.2, P = 0.004), and high waist circumference (>102 cm) (9.0 vs. 11.0, P = 0.020). Survivors with high fat percentage (≥25%) had significantly lower inhibin B/FSH ratios (inhibin B/FSH ratio: β -34%, P = 0.041). CONCLUSION Obesity is associated with gonadal dysfunction in male CCS, independent of the irreversible effect of previous cancer treatment. Randomized controlled trials are required to evaluate whether weight normalization could improve gonadal function, especially in obese survivors with potential other mechanisms than lifestyle causing their obesity.
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Affiliation(s)
- Karin Blijdorp
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Medicine - Section Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Greenfield DM, Boland E, Ezaydi Y, Ross RJM, Ahmedzai SH, Snowden JA. Endocrine, metabolic, nutritional and body composition abnormalities are common in advanced intensively-treated (transplanted) multiple myeloma. Bone Marrow Transplant 2014; 49:907-12. [DOI: 10.1038/bmt.2014.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/30/2014] [Accepted: 02/02/2014] [Indexed: 11/09/2022]
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van Dorp W, van der Geest IM, Laven JS, Hop WC, Neggers SJ, de Vries AC, Pieters R, van den Heuvel-Eibrink MM. Gonadal function recovery in very long-term male survivors of childhood cancer. Eur J Cancer 2013; 49:1280-6. [DOI: 10.1016/j.ejca.2012.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 11/29/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
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Green DM, Zhu L, Zhang N, Sklar CA, Ke RW, Kutteh WH, Klosky JL, Spunt SL, Metzger ML, Navid F, Srivastava D, Robison LL, Hudson MM. Lack of specificity of plasma concentrations of inhibin B and follicle-stimulating hormone for identification of azoospermic survivors of childhood cancer: a report from the St Jude lifetime cohort study. J Clin Oncol 2013; 31:1324-8. [PMID: 23423746 DOI: 10.1200/jco.2012.43.7038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many male survivors of childhood cancer are at risk for azoospermia. Although both the levels of follicle-stimulating hormone (FSH) and inhibin B are correlated with sperm concentration, their ability to predict azoospermia in survivors of childhood cancer remains uncertain. PATIENTS AND METHODS Semen analysis was performed and serum levels of FSH and inhibin B were measured in 275 adult male survivors of childhood cancer who had received gonadotoxic therapy. Receiver operating characteristic (ROC) analysis was performed to determine the optimal inhibin B and FSH values for identifying patients with azoospermia. The patient sample was divided into a learning set and a validation set. Sensitivity, specificity, and positive and negative predictive value were calculated. RESULTS Inhibin B was dichotomized as ≤ 31 ng/L or more than 31 ng/L and FSH was dichotomized as ≤ 11.5 mIU/mL or more than 11.5 mIU/mL based on results of the ROC analysis. Using these values, the specificity of the serum level of inhibin B for identifying azoospermic survivors was 45.0%, and the positive predictive value was 52.1%. The specificity for FSH was 74.1%, and the positive predictive value was 65.1%. CONCLUSION Neither serum inhibin B nor FSH is a suitable surrogate for determination of sperm concentration in a semen sample. Young men and their physicians should be aware of the limitations of these measures for assessment of fertility potential.
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Affiliation(s)
- Daniel M Green
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
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Küçük M, Bolaman AZ, Yavaşoğlu I, Kadıköylü G. Fertility-preserving treatment options in patients with malignant hematological diseases. Turk J Haematol 2012; 29:207-16. [PMID: 24744663 PMCID: PMC3986744 DOI: 10.5505/tjh.2012.72681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/20/2011] [Indexed: 11/04/2022] Open
Abstract
The number of patients of reproductive age diagnosed with various malignant hematological diseases increases every year. These patients undergo chemotherapy, radiotherapy, and various other treatments that may have gonadotoxic effects. The life expectancy of these patients is increasing rapidly due to the variety of treatment options. As such, an increasing number of patients-as well as their parents and spouses-express their concerns about the patient's fertility post treatment. In the present review it was aimed to provide an overview of current fertility-preserving treatment options and the future of fertility preservation.
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Affiliation(s)
- Mert Küçük
- Adnan Menderes University, School of Medicine, Department of Obstetrics and Gynecology, Aydın, Turkey
| | - Ali Zahit Bolaman
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
| | - Irfan Yavaşoğlu
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
| | - Gürhan Kadıköylü
- Adnan Menderes University, School of Medicine, Department of Internal Medicine, Division of Hematology, Aydın, Turkey
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van Waas M, Neggers S, te Winkel M, Beishuizen A, Pieters R, van den Heuvel-Eibrink M. Endocrine late sequelae in long-term survivors of childhood non-Hodgkin lymphoma. Ann Oncol 2012; 23:1626-32. [DOI: 10.1093/annonc/mdr511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rendtorff R, Beyer M, Müller A, Dittrich R, Hohmann C, Keil T, Henze G, Borgmann A. Low inhibin B levels alone are not a reliable marker of dysfunctional spermatogenesis in childhood cancer survivors. Andrologia 2012; 44 Suppl 1:219-25. [DOI: 10.1111/j.1439-0272.2011.01167.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Semen quality and fertility in adult long-term survivors of childhood acute lymphoblastic leukemia. Fertil Steril 2011; 96:837-42. [DOI: 10.1016/j.fertnstert.2011.07.1147] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/17/2011] [Accepted: 07/27/2011] [Indexed: 11/20/2022]
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Long-term endocrine side effects of childhood Hodgkin's lymphoma treatment: a review. Hum Reprod Update 2011; 18:12-28. [DOI: 10.1093/humupd/dmr038] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Harel S, Fermé C, Poirot C. Management of fertility in patients treated for Hodgkin's lymphoma. Haematologica 2011; 96:1692-9. [PMID: 21828120 DOI: 10.3324/haematol.2011.045856] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The risk of developing premature ovarian failure and azoospermia is a major concern in long-term survivors treated for Hodgkin's lymphoma. Alkylating chemotherapy containing procarbazine and/or cyclophosphamide causes prolonged azoospermia in 90-100% of men and premature ovarian failure in 5-25% of women under the age of 30. The risk of infertility increases with the cumulative dose of alkylating agents and the risk is high after salvage therapy including conditioning and autologous or allogeneic transplantation. The doxorubicin-bleomycin-vinblastine-dacarbazine regimen is associated with a lower risk of gonadal damage; the rate of infertility is less than 10%. The risk of premature ovarian failure is limited after the doxorubicin-bleomycin-vinblastine-dacarbazine regimen. However, age is an important factor; women over 30 years of age are at a much higher risk of ovarian failure. Semen cryopreservation should be routinely offered, especially before initial treatment with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone or salvage therapy with high-dose chemotherapy and autologous transplantation. For women with a stable partner, in vitro fertilization for embryo cryopreservation is a routine procedure but can only be offered to a small number of patients and requires a delay in treatment initiation for at least four weeks. Cryopreservation of mature or immature oocytes remains experimental. Ovarian tissue cryopreservation is promising but has so far resulted in only a small number of pregnancies and births. This method, usually involving the removal of an entire ovary, is only proposed before treatment leading to a high risk of infertility. Analogs of LHRH were investigated in order to preserve fertility in women but are not recommended in the absence of studies demonstrating their effectiveness. The risk of secondary infertility should be discussed with patients from the time of the diagnosis and requires multidisciplinary collaboration between hematologists and Assisted Reproductive Techniques (ART) teams.
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Affiliation(s)
- Stephanie Harel
- Service d’Immuno-Hématologie, Hôpital Saint-Louis, Paris, France
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Ginsberg JP. Educational paper: the effect of cancer therapy on fertility, the assessment of fertility and fertility preservation options for pediatric patients. Eur J Pediatr 2011; 170:703-8. [PMID: 21127904 DOI: 10.1007/s00431-010-1359-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/10/2010] [Indexed: 01/15/2023]
Abstract
UNLABELLED Over the past several decades, pediatric oncologists have seen the growth in the number of patients surviving their cancer. This is in large part due to the use of multimodal therapy including chemotherapy, surgery, and radiotherapy. As the number of survivors of pediatric cancer continues to grow, however, we need to begin to focus on improving the quality of the lives that are being saved. Unfortunately, many regimens used today to cure pediatric cancer patients are gonadotoxic. Therefore, many of our survivors must contend with infertility. It is critical that pediatric oncologists consider the likelihood of gonadotoxicity prior to beginning therapy in this patient population in order to counsel patients and their families properly in order to potentially offer fertility preservation options. CONCLUSION Infertility is a critical quality of life issue for pediatric cancer survivors and their families. Fertility preservation techniques need to continue to be studied and developed in order to lessen the likelihood that future cancer survivors will be infertile. This review outlines the risk for infertility, provides an assessment of the survivors reproductive functioning, and summarizes the currently available methods of preserving fertility in pediatric cancer survivors.
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Affiliation(s)
- Jill P Ginsberg
- Division of Oncology, Center for Childhood Cancer Research, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
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Cuny A, Trivin C, Brailly-Tabard S, Adan L, Zerah M, Sainte-Rose C, Alapetite C, Brugières L, Habrand JL, Doz F, Brauner R. Inhibin B and anti-Müllerian hormone as markers of gonadal function after treatment for medulloblastoma or posterior fossa ependymoma during childhood. J Pediatr 2011; 158:1016-1022.e1. [PMID: 21168856 DOI: 10.1016/j.jpeds.2010.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 09/10/2010] [Accepted: 11/05/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the roles of hypothalamic-pituitary and spinal irradiations and chemotherapy in gonadal deficiency after treatment for medulloblastoma or posterior fossa ependymoma by measuring levels of plasma inhibin B and antimüllerian hormone (AMH). STUDY DESIGN A total of 34 boys and 22 girls were classified as having normal levels of plasma follicle-stimulating hormone (FSH; <9 IU/L), or abnormal levels of FSH (>9 IU/L) and luteinizing hormone (LH; <5 or >5 IUL). RESULTS Two boys had partial gonadotropin deficiency, combined with testicular deficiency in one boy. Six boys had increased levels of FSH, indicating tubular deficiency, combined with Leydig cell deficiency in 5 boys. The 7 boys with inhibin B levels <100 ng/mL included the one with combined deficiencies and the 6 with testicular deficiency. Puberty did not progress in 7 girls; 3 had gonadotropin deficiency, combined with ovarian deficiency in one, and 4 had increased FSH levels, indicating ovarian deficiency. Inhibin B and AMH levels were low in the girl with combined deficiencies, in the 4 girls with ovarian deficiency, and in 4 girls with normal clinical-biological ovarian function, including 2 who underwent ovarian transposition before irradiation. CONCLUSION The plasma concentrations of inhibin B and AMH are useful means of detecting primary gonad deficiency in patients with no increase in their plasma gonadotropin levels because of radiation-induced gonadotropin deficiency.
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Affiliation(s)
- Ariane Cuny
- Université Paris Descartes and AP-HP, Hôpital Bicêtre, Unité d'endocrinologie pédiatrique, Le Kremlin Bicêtre, France
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Leader A, Lishner M, Michaeli J, Revel A. Fertility considerations and preservation in haemato-oncology patients undergoing treatment. Br J Haematol 2011; 153:291-308. [DOI: 10.1111/j.1365-2141.2011.08629.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Laporte S, Couto-Silva AC, Trabado S, Lemaire P, Brailly-Tabard S, Espérou H, Michon J, Baruchel A, Fischer A, Trivin C, Brauner R. Inhibin B and anti-Müllerian hormone as markers of gonadal function after hematopoietic cell transplantation during childhood. BMC Pediatr 2011; 11:20. [PMID: 21352536 PMCID: PMC3058047 DOI: 10.1186/1471-2431-11-20] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 02/25/2011] [Indexed: 11/21/2022] Open
Abstract
Background It is difficult to predict the reproductive capacity of children given hematopoietic cell transplantation (HCT) before pubertal age because the plasma concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are not informative and no spermogram can be done. Methods We classified the gonadal function of 38 boys and 34 girls given HCT during childhood who had reached pubertal age according to their pubertal development and FSH and LH and compared this to their plasma inhibin B and anti-Müllerian hormone (AMH). Results Ten (26%) boys had normal testicular function, 16 (42%) had isolated tubular failure and 12 (32%) also had Leydig cell failure. All 16 boys given melphalan had tubular failure. AMH were normal in 25 patients and decreased in 6, all of whom had increased FSH and low inhibin B. Seven (21%) girls had normal ovarian function, 11 (32%) had partial and 16 (47%) complete ovarian failure. 7/8 girls given busulfan had increased FSH and LH and 7/8 had low inhibin B. AMH indicated that ovarian function was impaired in all girls. FSH and inhibin B were negatively correlated in boys (P < 0.0001) and girls (P = 0.0006). Neither the age at HCT nor the interval between HCT and evaluation influenced gonadal function. Conclusion The concordance between FSH and inhibin B suggests that inhibin B may help in counselling at pubertal age. In boys, AMH were difficult to use as they normally decrease when testosterone increases at puberty. In girls, low AMH suggest that there is major loss of primordial follicles.
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Affiliation(s)
- Sylvie Laporte
- Université Paris Descartes and AP-HP, Hôpital Bicêtre, Unité d'Endocrinologie Pédiatrique, Le Kremlin Bicêtre, France.
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Smit M, van Casteren NJ, Wildhagen MF, Romijn JC, Dohle GR. Sperm DNA integrity in cancer patients before and after cytotoxic treatment. Hum Reprod 2010; 25:1877-83. [PMID: 20551071 DOI: 10.1093/humrep/deq104] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed sperm DNA fragmentation index (DFI) in cancer patients before and after treatment to evaluate if sperm DNA integrity is compromised by cancer itself or its treatment. METHODS In a prospective study, DFI was assessed in 127 patients diagnosed with testicular germ cell tumours (TGCT), Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL) and various malignancies. The severity of cancer and tumour markers at diagnosis was recorded. Follow-up DFI after treatment was available in 52 patients who were mostly less severely affected. RESULTS In patients diagnosed with TGCT, HL and various malignancies, pretreatment DFI levels were not significantly different from that of proven fertile controls, but in patients with NHL an increased DFI was found. An overall significant decrease in post-treatment DFI (13.2% range 5.0-70.5) compared with pretreatment values (17.1% range 5.1-66.6) was found (P = 0.040). In TGCT patients, post-treatment DFI was significantly higher in patients who were treated with radiotherapy (16.9% range 11.5-39.9) compared with that in patients treated with chemotherapy (CT) alone (10.9% range 5.5-39.9) (P = 0.037). In HL patients, the type of treatment or number of CT cycles was not associated with DFI. Overall, post-treatment DFI in cancer patients was not significantly different from that of proven fertile controls. CONCLUSIONS In this study, the presence of cancer does not seem to negatively affect the sperm DNA integrity in TGCT and HL patients; only NHL patients showed increased DFI at the time of diagnosis compared with healthy controls. Our results confirm previous reports that DFI decreases significantly following various anti-cancer treatments. In contrast, radiotherapy in TGCT patients is associated with an increase in DFI compared with CT treatment alone.
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Affiliation(s)
- M Smit
- Andrology Unit of the Department of Urology, Erasmus MC, 3000 CA Rotterdam, The Netherlands.
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van Waas M, Neggers S, Pieters R, van den Heuvel-Eibrink M. Components of the metabolic syndrome in 500 adult long-term survivors of childhood cancer. Ann Oncol 2010; 21:1121-6. [DOI: 10.1093/annonc/mdp414] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wyns C, Curaba M, Vanabelle B, Van Langendonckt A, Donnez J. Options for fertility preservation in prepubertal boys. Hum Reprod Update 2010; 16:312-28. [DOI: 10.1093/humupd/dmp054] [Citation(s) in RCA: 207] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Cranial irradiation does not result in pituitary–gonadal axis dysfunction in very long-term male survivors of childhood acute lymphoblastic leukemia. Leukemia 2009; 23:2310-3. [DOI: 10.1038/leu.2009.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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