Ovarian function in survivors of childhood medulloblastoma: Impact of reduced dose craniospinal irradiation and high-dose chemotherapy with autologous stem cell rescue

• Published in: Pediatric blood & cancer Vol. 62; no. 2; pp. 317 - 321
• Main Authors: Balachandar, Sadana, Dunkel, Ira J., Khakoo, Yasmin, Wolden, Suzanne, Allen, Jeffrey, Sklar, Charles A.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.02.2015; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; autologous stem cell rescue; Cerebellar Neoplasms - drug therapy; Cerebellar Neoplasms - radiotherapy; Chemotherapy; Child; Child, Preschool; Combined Modality Therapy; Cranial Irradiation - adverse effects; Cranial Irradiation - methods; craniospinal irradiation; Craniospinal Irradiation - adverse effects; Craniospinal Irradiation - methods; Female; Fertility Preservation; Hematology; Hormone replacement therapy; Hormone Replacement Therapy - methods; Humans; Infant; medulloblastoma; Medulloblastoma - drug therapy; Medulloblastoma - radiotherapy; Oncology; ovarian function; Ovary - pathology; Pediatrics; premature ovarian failure; primary ovarian dysfunction; Primary Ovarian Insufficiency - prevention & control; Retrospective Studies; Stem Cell Transplantation - methods; Stem cells; Young Adult; craniospinal irradiation; autologous stem cell rescue; primary ovarian dysfunction; medulloblastoma; premature ovarian failure; ovarian function
• ISSN: 1545-5009; 1545-5017; 1545-5017
• DOI: 10.1002/pbc.25291

Background Data on ovarian function (OvF) in medulloblastoma (MB) survivors is limited, with most studies describing outcomes in survivors treated with craniospinal irradiation (CSI) doses >24 Gy ± standard chemotherapy. The objective of the current study is to report on OvF: (i) across a range of CSI doses; and (ii) following high‐dose chemotherapy with autologous stem cell rescue (ASCR). Procedure Retrospective review of female MB survivors who were diagnosed in childhood and followed at Memorial Sloan Kettering Cancer Center. Patients were divided into three groups: (i) CSI ≤24 Gy +/− standard chemotherapy; (ii) CSI ≥35 Gy +/− standard chemotherapy; and (iii) high‐dose chemotherapy with ASCR +/− CSI. Results Primary ovarian dysfunction (POD) occurred in 2/17 subjects in group 1, 3/9 subjects in group 2 and 5/5 subjects in group 3 (P < 0.01). Normalization of function was noted in four subjects with POD. Persistent POD requiring hormone replacement (POF) was observed in 1/17 subjects in group 1, 2/9 in group 2, and 3/5 in group 3 (P = 0.02). Neither age at treatment nor type of standard chemotherapy correlated with risk of POD or POF. Conclusions Both POD and POF appear to occur in a small proportion of patients who are treated with contemporary doses of CSI +/− standard chemotherapy. However, ovarian dysfunction requiring hormone replacement therapy is common following high‐dose chemotherapy associated with ASCR. These findings will assist clinicians in counseling patients regarding fertility preservation and risk of impaired ovarian function/future fertility. Pediatr Blood Cancer 2015;62:317–321. © 2014 Wiley Periodicals, Inc.