BACKGROUND: Gonadal damage in adult patients after chemotherapy for Hodgkin's disease is well documented, but data of patients treated before adulthood are scarce. METHODS: Gonadal and hormonal function were studied in 19 male long term survivors of Hodgkin's disease who were treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP chemotherapy) before (n = 15) or during puberty (n = 4). The studies were performed a median of 10 years after treatment and repeated in the majority of the patients at the time of yearly visits. RESULTS: Germ cell damage was present in all patients. Semen analysis revealed azoospermia in 12 patients and oligospermia in 6; no recovery of spermatogenesis was seen at follow-up. Testicular size was small in all but one patient. Follicle-stimulating hormone levels were elevated (mean, 14.4 +/- 7.8 U/l) and increased over time (mean, 21.1 +/- 10.5 U/l, P < 0.001). In seven patients, luteinizing hormone (LH) was elevated, indicating Leydig cell dysfunction; also in four of those patients, plasma testosterone was decreased. In three other patients, the response of LH to gonadotropin-releasing hormone was exaggerated with a normal basal LH and testosterone. Comparing testicular function of prepubescent versus pubescent state at time of treatment appears to show a trend for improved outcome in the younger patients. CONCLUSIONS: Gonadal function of long term survivors of pediatric Hodgkin's disease treated with MOPP chemotherapy is severely impaired permanently.
BACKGROUND: Gonadal damage in adult patients after chemotherapy for Hodgkin's disease is well documented, but data of patients treated before adulthood are scarce. METHODS: Gonadal and hormonal function were studied in 19 male long term survivors of Hodgkin's disease who were treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP chemotherapy) before (n = 15) or during puberty (n = 4). The studies were performed a median of 10 years after treatment and repeated in the majority of the patients at the time of yearly visits. RESULTS: Germ cell damage was present in all patients. Semen analysis revealed azoospermia in 12 patients and oligospermia in 6; no recovery of spermatogenesis was seen at follow-up. Testicular size was small in all but one patient. Follicle-stimulating hormone levels were elevated (mean, 14.4 +/- 7.8 U/l) and increased over time (mean, 21.1 +/- 10.5 U/l, P < 0.001). In seven patients, luteinizing hormone (LH) was elevated, indicating Leydig cell dysfunction; also in four of those patients, plasma testosterone was decreased. In three other patients, the response of LH to gonadotropin-releasing hormone was exaggerated with a normal basal LH and testosterone. Comparing testicular function of prepubescent versus pubescent state at time of treatment appears to show a trend for improved outcome in the younger patients. CONCLUSIONS: Gonadal function of long term survivors of pediatric Hodgkin's disease treated with MOPP chemotherapy is severely impaired permanently.
Authors: Wassim Chemaitilly; Qi Liu; Laura van Iersel; Kirsten K Ness; Zhenghong Li; Carmen L Wilson; Tara M Brinkman; James L Klosky; Nicole Barnes; Karen L Clark; Rebecca M Howell; Susan A Smith; Matthew J Krasin; Monika L Metzger; Gregory T Armstrong; Michael W Bishop; Hanneke M van Santen; Ching-Hon Pui; Deo Kumar Srivastava; Yutaka Yasui; Melissa M Hudson; Leslie L Robison; Daniel M Green; Charles A Sklar Journal: J Clin Oncol Date: 2019-09-26 Impact factor: 44.544
Authors: Daniel M Green; Toana Kawashima; Marilyn Stovall; Wendy Leisenring; Charles A Sklar; Ann C Mertens; Sarah S Donaldson; Julianne Byrne; Leslie L Robison Journal: J Clin Oncol Date: 2009-11-30 Impact factor: 44.544
Authors: Daniel M Green; Charles A Sklar; John D Boice; John J Mulvihill; John A Whitton; Marilyn Stovall; Yutaka Yasui Journal: J Clin Oncol Date: 2009-04-13 Impact factor: 44.544
Authors: Christopher L R Barratt; Lars Björndahl; Christopher J De Jonge; Dolores J Lamb; Francisco Osorio Martini; Robert McLachlan; Robert D Oates; Sheryl van der Poel; Bianca St John; Mark Sigman; Rebecca Sokol; Herman Tournaye Journal: Hum Reprod Update Date: 2017-11-01 Impact factor: 15.610