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
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.