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Factors affecting gonadal function after bone marrow transplantation during childhood.
A C Couto-Silva1, C Trivin, E Thibaud
1Pediatric Endocrinology Department, Université Paris V and Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France.
Bone Marrow Transplantation
|August 11, 2001
Summary
Bone marrow transplantation conditioning can cause gonadal failure in children. Girls are more likely to experience ovarian failure with increasing age at transplantation, though early recovery is possible. Boys may experience testicular dysfunction, with inhibin B indicating tubular function.
Area of Science:
- Endocrinology
- Hematology
- Oncology
Background:
- Bone marrow transplantation (BMT) conditioning regimens, including total body irradiation (TBI) and chemotherapy, can impact gonadal function and hormone production.
- Assessing the long-term effects of BMT conditioning on reproductive health is crucial for pediatric survivors.
Purpose of the Study:
- To analyze risk factors for gonadal failure following different BMT conditioning protocols in children.
- To evaluate the incidence of ovarian and testicular dysfunction and potential for recovery.
Main Methods:
- Retrospective analysis of 75 patients (34 girls, 41 boys) who underwent BMT at a median age of 7.7 years.
- Patients received different conditioning regimens: 12 Gy TBI (six fractions), 10 Gy TBI (one dose), 6 Gy total lymphoid irradiation (TLI), or chemotherapy alone.
- Hormonal assessments (FSH, LH, testosterone, inhibin B) and clinical evaluations of gonadal function were performed.
Main Results:
- Complete ovarian failure occurred in 64.7% of girls, with a positive correlation between age at BMT and FSH levels.
- Spontaneous recovery of FSH was observed in 6 cases and LH in 2 cases.
- Testicular tubular failure occurred in 61% of boys, with 39% experiencing normal testicular function. A negative correlation between FSH and inhibin B was noted in boys.
Conclusions:
- Girls are at higher risk for ovarian failure with increasing age at BMT, but early recovery is possible.
- In boys, inhibin B may serve as an additional indicator of testicular tubular function.
- BMT conditioning significantly impacts gonadal function, necessitating long-term monitoring and potential interventions.