OVARIAN-FUNCTION AFTER BONE-MARROW TRANSPLANTATION DURING CHILDHOOD

Ovarian failure is often brought about by the conditioning protocol us ed for bone marrow transplantation (BMT). We monitored ovarian functio n in 31 girls conditioned for BMT at 10.3 +/- 0.6 (s.e., 3.2-17.5) yea rs by chemotherapy alone (group 1, n = 8) or chemotherapy plus body ir radiation (12 Gy, fractionated in group 2, n = 9, or 10 Gy single tota l body in group 3, n = 7, and 5 or 6 Gy single thoraco-abdominal in gr oup 4, n = 7, irradiation) at 13.4 +/- 0.4 (11.7-18.6) years, Breast d evelopment was normal (n = 11), did not occur (n = 14), or did not pro gress spontaneously (n = 2) after BMT, The other four girls who menstr uated before BMT had permanent amenorrhea, Basal plasma gonadotropin c oncentrations were measured in 29; follicle-stimulating hormone was in creased in them all and luteinizing hormone in 25, At the last clinica l evaluation at 16.3 +/- 11.4 (12.1-21.6) years, 23 girls had complete ovarian failure, two had partial ovarian failure, and six had normal ovarian function, Three of these were the youngest group 1 patients an d those who had not received busulfan, We conclude that conditioning f or BMT given during childhood frequently prevents normal estrogen secr etion at puberty, Adequate substitutive treatment may be necessary to induce growth acceleration and sexual development.