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Chun, Ji, and Joo: GnRH Agonist Co-treatment for Prevention of Primary Ovarian Insufficiency in Patients with Hematologic Malignancies Undergoing Chemotherapy
Original Article

The Journal of Korean Society of Menopause 2013; 19(2): 93-100.

Published online: 27 August 2013

DOI: https://doi.org/10.6118/jksm.2013.19.2.93

GnRH Agonist Co-treatment for Prevention of Primary Ovarian Insufficiency in Patients with Hematologic Malignancies Undergoing Chemotherapy

Sungwook Chun, M.D., Ph.D.1, Yong Il Ji, M.D., Ph.D.1, Young Don Joo, M.D., Ph.D.2

1Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea.

2Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.

Address for Correspondence: Sungwook Chun, Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hoispital, 875 Haeun-daero, Haeundae-gu, Busan 612-896, Korea. Tel: +82-51-797-2020, Fax: +82-51-797-2030, wooki1974@empal.com

Received 19 June 2013       Revised 9 July 2013       Accepted 22 July 2013

Copyright © 2013 by The Korean Society of Menopause

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Objectives

The aim of this study was to assess the effect of gonadotropin-releasing hormone (GnRH) agonist co-treatment for gonadal protection in patients with hematologic neoplasms undergoing chemotherapy.

Methods

Young premenopausal women who were diagnosed with leukemia or lymphoma between March 2010 and February 2012 and undergoing chemotherapy in a university hospital were included in this study.

Results

Twenty-nine patients aged 15.39 years participated in this study. Among the patients, five patients were receiving leuprolide concomitant with chemotherapy, and twenty-four patients were receiving chemotherapy alone. Seventeen patients in the chemotherapy alone group stopped menstrating and were diagnosed with primary ovarian insufficiency (POI) within one year after chemotherapy; and only one patient had POI in the chemotherapy plus leuprolide group, but these differences were not statistically significant (P = 0.054). In the chemotherapy plus leuprolide group, serum anti-mullerian hormone (AMH) levels were significantly lower than basal serum AMH levels (5.57 ± 0.18 ng/mL) (P < 0.001) after treatment (1.84 ± 0.22 ng/mL).

Conclusion

GnRH agonist may be a promising option for the prevention of POF, but the effectiveness of GnRH agonist is still debatable. A large prospective multi-center trial with adequate follow-up is needed.

Keywords: Anti-mullerian hormone, Chemotherapy, GnRH agonist, Hematologic neoplasms, Primary ovarian insufficiency

Figures and Tables

Fig. 1
Flow chart of study participants. POI: primary ovarian insufficiency
jksm-19-93-g001
Table 1
The baseline characteristics of patients in study group
jksm-19-93-i001

NHL: non-Hodgkin's lymphoma, HL: Hodgkin's lymphoma, ALL: acute lymphocytic leukemia, BMT: bone marrow transplantation, HSCT: hematopoietic stem cell transplantation

Table 2
Gap times between initial injection of gonadotropin-releasing hormone (GnRH) agonist and start of chemotherapy and those between termination of chemotherapy and final injection of GnRH agonist
jksm-19-93-i002

Values are mean ± SE.

Gap time 1: duration of time between onset of GnRH agonist and start of chemotherapy. Gap time 2: duration of time between termination of chemotherapy and termination of GnRH agonist

Table 3
Comparisons between serum AMH levels before onset of gonadotropin-releasing hormone (GnRH) agonist co-treatment and those after termination of GnRH agonist
jksm-19-93-i003

Values are mean ± SE.

Rate of decline: (AMHpre - AMHpost) / AMHpre × 100 (%). P value by Wilcoxon signed rank test; P* value by Kolmogorov-Smirnov test.

AMH: anti-Mullerian hormone, POI: primary ovarian insufficiency, AMHpre: serum AMH level before GnRH agonist suppression, AMHpost: serum AMH level 4 weeks after final GnRH agonist injection

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