IMPE2023 Poster Presentations Sex Differentiation, Gonads and Gynaecology, and Sex Endocrinology (19 abstracts)
Ovarian cell dysfunction at diagnosis in girls with haematological malignancies
Jimena Lopez Dacal 1 , Silvina Prada 2 , Andrea Arcari 1 , Analia Freire 1 , Mirta Gryngarten 1 , Maria Gabriela Ropelato 1 , Maria Gabriela Ballerini 1 , Maria Eugenia Rodriguez 1 , Marcela Gutierrez 2 , Marcela Soria 2 , Lorena Morán 2 , Cristina E. Ferraro 2 , Patricia Bedecarrás 1 , Guillermo Drelichman 2 , Luis Aversa 2 , Ignacio Bergadá 1 , Rodolfo A. Rey 1 & Romina P. Grinspon 1
1Centro de Investigaciones Endocrinológicas “Dr. César Bergadá” (CEDIE), CONICET – FEI – División de Endocrinología. Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. 2División de Hematología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
Introduction: Haematological malignancies represent the most frequent childhood cancer. Little is known about small ovarian follicle function at diagnosis in girls with acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML) or non-Hodgkin lymphoma (NHL). AMH is a useful marker of small follicles.
Aim: To determine small ovarian follicle status at diagnosis and after 3 months of chemotherapy in girls and adolescents by measuring serum AMH.
Methods: In a prospective cohort study including girls with ALL, AML or NHL, AMH was measured at diagnosis and after 3 months of chemotherapy. Secondarily, FSH levels were analysed. Results were expressed as median (range).
Results: 82 girls, aged 6.9 years (0.2-15.7) were included: 53 (64.6%) were prepubertal and 29 (35.4%) pubertal. 63.4% of the girls had ALL, 20.7% AML and 15.9% NHL. All pubertal girls received GnRH analogue. In prepubertal girls (Table), median AMH was decreased at diagnosis, and 13/53 (24.5%) had AMH <3rd centile. Patients with ALL had the lowest AMH levels. After 3 months of chemotherapy, median AMH decreased and 25/53 (47.2%) had serum AMH <3rd centile. In pubertal girls, median AMH was within normal reference levels at diagnosis, and only 3/29 girls (10.3%) had AMH <3rd centile. After 3 months of chemotherapy, AMH decreased significantly, showing levels <3rd centile in 11/29 (37.9%) of the girls. FSH levels were within the normal range at diagnosis in both prepubertal and pubertal girls, showing a slight increase in prepubertal girls. In pubertal girls, interpretation was hampered due to treatment with GnRH analogue.
| AMH at diagnosis | AMH at 3 months | |||
| pmol/L median (range) | <3rd centile n(%) | pmol/L median (range) | <3rd centile n(%) | |
| Pre-pubertal | 8.5 (1.2-55.0) | 13 (24.5) | 4.9 (1.2-38.0) | 25 (47.2) |
| ALL (n=36) | 8.4 (1.2-55.0) | 10 (27.8) | 7.65 (1.2-38.0) | 10 (27.8) |
| AML (n=8) | 11.45 (2.0-32.0) | 2 (25) | 2.5 (1.2-4.2) | 8 (100) |
| NHL (n=9) | 13.8 (1.2-55.0) | 1 (11.1) | 2.5 (1.2-32.6) | 7 (77.7) |
| Pubertal | 16.9 (1.2-80.0) | 3 (10.3) | 5.4 (1.2-48.0) | 11 (37.9) |
| ALL (n=16) | 14.2 (2.6-80.0) | 1 (6.25) | 7.25 (3.0-48.0) | 2 (12.5) |
| AML (n=9) | 19.0 (1.2-35.0) | 2 (22.2) | 3.0 (1.2-7.0) | 7 (77.7) |
| NHL (n=4) | 14.95 (5.4-30.3) | 0 (0,0) | 6.6 (1.2-14.4) | 2 (50.0) |
Ref. levels <18 yr, median (3-97 centiles): 18.1 (4.2-55.6) pmol/L.
Conclusion: Prepubertal girls with haematological malignancies, especially those with ALL, have lower serum AMH at diagnosis as compared to the reference values, reflecting a small ovarian follicle dysfunction. After 3 months of chemotherapy, AMH concentration significantly decreased in prepubertal and pubertal girls.
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