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Anti-Müllerian hormone may signal gonadotoxicity in girls treated for cancer
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Researchers have identified the anti-Müllerian hormone as a marker of early gonadotoxicity in pre- and postpubertal girls treated for cancer, according to a prospective cohort study.
Previous studies investigating ovarian reserve in adults after treatment for childhood cancer demonstrated low anti-Müllerian hormone concentrations, but accurate assessments of the risk to individual patients of subfertility or infertility before and after cancer treatment remain a challenge, researchers wrote.
In the 4-year study, researcher Mark F.H. Brougham, MRCP, of the department of pediatric hematology and oncology at Royal Hospital for Sick Children, in Edinburgh, United Kingdom, and colleagues measured anti-Müllerian hormone, inhibin B and gonadotoxicity before, during and after the completion of cancer treatment in 22 girls (17 prepubertal) aged 0.3 to 15 years.
“A marker of ovarian function, particularly in the prepubertal age group, would improve future identification of those to whom fertility preservation strategies should be addressed,” researchers wrote.
Participants diagnosed with malignancy that required treatment with pulsed chemotherapy or radiotherapy were enrolled in the study. Those with acute lymphoblastic leukemia, a brain tumor requiring cranial irradiation, gonadal tumor and primary gonadal dysgenesis were excluded from the study.
At diagnosis, participants were classified as prepubertal (Tanner stage 1), mid-puberty (Tanner stage 2/3) or late puberty (Tanner stage 4/5), besides being categorized into low, medium or high, according to their predicted risk for gonadotoxicity.
Blood samples were taken at diagnosis, baseline and before and after each chemotherapy cycle, with follow-up samples taken a minimum of 6 months after the completion of treatment.
Anti-Müllerian hormone was detectable in participants of all ages, and researchers wrote that it falls rapidly during chemotherapy in prepubertal and pubertal girls (P<.0001).
They also found that anti-Müllerian hormone became undetectable in 50% of participants, with recovery in the low/medium risk group after the completion of treatment.
In the high-risk group, anti-Müllerian hormone became undetectable in all participants, with no recovery. With follicle-stimulating hormone, inhibin B was also undetectable in most before treatment, and no clear relationship to treatment.
Disclosure: Dr. Richard A. Anderson has undertaken consultancy work for Beckman Coulter and Roche Diagnostics. The other researchers report no relevant financial disclosures.
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