INCIDENCE OF OVARIAN FAILURE IN SYSTEMIC LUPUS-ERYTHEMATOSUS AFTER TREATMENT WITH PULSE CYCLOPHOSPHAMIDE

Citation
Em. Mcdermott et Rj. Powell, INCIDENCE OF OVARIAN FAILURE IN SYSTEMIC LUPUS-ERYTHEMATOSUS AFTER TREATMENT WITH PULSE CYCLOPHOSPHAMIDE, Annals of the Rheumatic Diseases, 55(4), 1996, pp. 224-229
Citations number
39
Categorie Soggetti
Rheumatology
ISSN journal
00034967
Volume
55
Issue
4
Year of publication
1996
Pages
224 - 229
Database
ISI
SICI code
0003-4967(1996)55:4<224:IOOFIS>2.0.ZU;2-S
Abstract
Objective-To investigate the incidence of ovarian failure after pulse cyclophosphamide treatment in systemic lupus erythematosus (SLE) and t o compare this with two control groups: SLE patients treated with azat hioprine, and a healthy age matched population. Methods-All women pati ents with SLE treated with pulse cyclophosphamide in our department we re identified and questioned concerning menstrual history. All the hos pital notes were reviewed and details recorded on dose of cyclophospha mide, duration of treatment, side effects and lowest pretreatment neut rophil and leucocyte counts during the course of treatment. Disease co ntrols were recruited from our department and healthy controls from th e local family health services authority (FHSA) register. Results-Inci dence of ovarian failure in the premenopausal cyclophosphamide treated group was 54% and the incidence of premature menopause (occurring bef ore age 40 years) was 41%. Increasing age at start of treatment showed a linear trend with incidence of ovarian failure (p = 0.01). Using lo gistic regression, increasing duration of treatment was related to inc idence of ovarian failure (p = 0.047 in those treated age 35 years or younger). An association between the lowest neutrophil count throughou t the treatment period, when taken immediately before each planned cyc lophosphamide pulse, and the incidence of ovarian failure was also dem onstrated (p = 0.04 in those treated before age 40 years). Conclusion- Ovarian failure-in particular, premature failure after treatment with pulse cyclophosphamide-is common. Factors associated with increased ri sk include greater age at start of treatment, longer period of treatme nt, and greater degree of marrow suppression as assessed by the neutro phil count immediately before each planned cyclophosphamide pulse.