GONADAL-FUNCTION FOLLOWING CHEMOTHERAPY FOR CHILDHOOD HODGKINS-DISEASE

Gonadal function was assessed in 101 postpubertal subjects after chemo therapy for childhood Hodgkin's disease. All had received ChlVPP (chlo rambucil, vinblastine procarbazine, and prednisolone) chemotherapy alo ne, with no radiotherapy below the diaphragm. Gonadotropin levels were available in 46 (79.3%) male and 32 (74.4%) female subjects. The mean age at diagnosis in the male cohort was 12.2 years (range 8.2-15.3) a nd in the females 13.0 years (9.0-15.2). The males and the females wer e studied at a median of 6 years (range 2.5-11.1) and 4.3 years (range 1.9-11.5) from diagnosis, respectively. Forty-one (89.1%) male subjec ts had elevated follicle-stimulating hormone (FSH) levels, confirming severe germinal epithelial damage. Germinal epithelial damage was seen in subjects up to 10 years out of therapy. Subtle Leydig cell dysfunc tion was identified in 24.4% with raised luteinizing hormone (LH) leve ls. All subjects, however, progressed spontaneously through puberty. S eventeen (53%) women had raised gonadotropin levels, with variable est radiol levels. Of these, 10 subjects presented with symptomatic ovaria n failure and 6 received hormone replacement therapy (HRT). Nine women had 11 successful pregnancies, two of whom had previously had symptom s of ovarian failure with one requiring HRT. A much higher prevalence of ovarian failure has been observed, than has previously been conside red in the prepubertal and pubertal female following combination chemo therapy. These conclusions have important implications for future coun seling, management, and research in this population. (C) 1996 Wiley-Li ss, Inc.