K E Palinska-Rudzka1, T Ghobara2, N Parsons3, J Milner4, G Lockwood4, G M Hartshorne5. 1. Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK. 2. University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK. 3. Warwick Medical School, University of Warwick Coventry CV4 7AL, UK. 4. CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK. 5. Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK. Electronic address: geraldine.hartshorne@warwick.ac.uk.
Abstract
RESEARCH QUESTION: An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN: A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS: After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS: Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy. Crown
RESEARCH QUESTION: An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN: A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS: After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancerpatients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS: Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy. Crown
Authors: Kathryn J Ruddy; Daniel J Schaid; Anthony Batzler; Reena S Cecchini; Ann H Partridge; Aaron Norman; Louis Fehrenbacher; Elizabeth A Stewart; Emanuel Trabuco; Elizabeth Ginsburg; Fergus J Couch; Peter A Fasching; Celine Vachon; Patricia A Ganz Journal: J Natl Cancer Inst Date: 2021-08-02 Impact factor: 13.506