%0 Journal Article
%T Ovarian Reserve in Women Treated for Acute Lymphocytic Leukemia or Acute Myeloid Leukemia with Chemotherapy, but Not Stem Cell Transplantation
%A Brooke V. Rossi
%A Stacey Missmer
%A Katharine F. Correia
%A Martha Wadleigh
%A Elizabeth S. Ginsburg
%J ISRN Oncology
%D 2012
%R 10.5402/2012/956190
%X Purpose. It is well known that chemotherapy regimens may have a negative effect on ovarian reserve, leading to amenorrhea or premature ovarian failure. There are little data regarding the effects of leukemia chemotherapy on ovarian reserve, specifically in women who received the chemotherapy as adults and are having regular menstrual periods. Our primary objective was to determine if premenopausal women with a history of chemotherapy for leukemia, without subsequent stem cell transplantation, have decreased ovarian reserve. Materials and Methods. We measured ovarian reserve in five women who had been treated for acute lymphocytic leukemia (ALL) or acute myeloid leukemia (AML) and compared them to age-matched control women without a history of chemotherapy. Results. There appeared to be a trend towards lower antimullerian hormone and antral follicle counts and higher follicle-stimulating hormone levels in the leukemia group. Conclusion. Our results indicate that chemotherapy for AML or ALL without stem cell transplantation may compromise ovarian reserve. Although our results should be confirmed by a larger study, oncologists, infertility specialists, and patients should be aware of the potential risks to ovarian function and should be counseled on options for fertility preservation. 1. Introduction Approximately 20,000 reproductive-aged American women carry a diagnosis of leukemia [1]. For women less than 45 years old at the time of diagnosis, the 5-year survival rate is approximately 50% and 40% for women with AML and ALL. Cancer patients are not only focused on survival, but on quality of life and long-term plans, such as family building. Health care providers have recognized the importance of fertility to cancer patients and the impact of cancer treatment on fertility. The American Society of Clinical Oncology recommends that fertility preservation be discussed at the time of diagnosis [2, 3]. Chemotherapeutics have a range of gonadotoxic effects. In general, methotrexate, fluorouracil, vincristine, bleomycin, and dactinomycin are associated with a low or no risk of amenorrhea, which is used as a surrogate marker for infertility, while alkylating agents are more likely to cause ovarian damage and amenorrhea [2]. Alkylating agents, like cyclophosphamide, may lead to early menopause by damaging primordial follicles [4, 5]. Anthracyclines, used for induction remission and postremission chemotherapy in young adults with acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL), also likely lead to ovarian damage [6, 7]. Ovarian reserve refers to
%U http://www.hindawi.com/journals/isrn.oncology/2012/956190/