Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort.

Premature Ovarian Insufficiency in Childhood Cancer Survivors: A Report from the St. Jude Lifetime Cohort.

J Clin Endocrinol Metab. 2017 Mar 24;:

Authors: Chemaitilly W, Li Z, Krasin MJ, Brooke RJ, Wilson CL, Green DM, Klosky JL, Barnes N, Clark KL, Farr JB, Fernandez-Pineda I, Bishop MW, Metzger M, Pui CH, Kaste SC, Ness KK, Srivastava DK, Robison LL, Hudson MM, Yasui Y, Sklar CA

Abstract
Context: Long-term follow-up data on premature ovarian insufficiency (POI) in childhood cancer survivors are limited.
Context: To describe the prevalence of POI, its risk factors and associated long-term adverse health outcomes.
Design: Cross-sectional.
Setting: The St. Jude Lifetime Cohort Study - established cohort in a tertiary care center.
Patients: 921 participants (median age 31.7 years) were evaluated at a median of 24.0 years after cancer diagnosis.
Main Outcome Measure: POI was defined by persistent amenorrhea combined with a follicle stimulating hormone level >30 IU/L before 40 years of age. Multivariable Cox regression was used to study associations between demographic or treatment-related risk factors and POI. Multivariable logistic regression was used to study associations between POI and markers for cardiovascular disease, bone mineral density (BMD) and frailty. Exposure to alkylating agents was quantified using the validated cyclophosphamide equivalent dose (CED).
Results: The prevalence of POI was 10.9%. Independent risk factors for POI included ovarian radiotherapy at any dose and CED ≥8,000 mg/m2. Patients with a BMI ≥30 kg/m2 at the time of the SJLIFE assessment were less likely to have a diagnosis of POI. Low BMD and frailty were independently associated with POI.
Conclusion: High dose alkylating agents and ovarian radiotherapy at any dose are associated with POI. Patients at the highest risk should be offered fertility preservation whenever feasible. POI contributes to poor general health outcomes in childhood cancer survivors; further studies are needed to investigate the role of sex hormone replacement in improving such outcomes.

PMID: 28368472 [PubMed - as supplied by publisher]

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