Gonadal function in young patients successfully treated for Hodgkin disease

Background. Gonadal function in pediatric and you ng adult survivors of Hod gkin disease is not very well defined. This study evaluates the outcome fol lowing the Multiple Drug Protocol (MDP) and the results are compared to the published experience. Procedure. Ovarian and testicular function was asses sed in 65 patients (36 males) with Hodgkin disease in first or second compl ete remission after treatment with either radiation (RT, n = 13), chemother apy (CT, n = 9), or both (n = 43). Chemotherapy consisted of six cycles of the MDP (doxorubicin, procarbazine, prednisone, vincristine, and cyclophosp hamide). Median age at diagnosis was 13.1 years (range, 2.4-22.6) and media n age at evaluation was 22.6 years (range, 15.1-33.7), which was 6.7 years (range, 2.0-19.8) after the completion of all treatments. For the purpose o f analysis, patients were divided into three groups: group A, patients who received only RT that did not include the pelvis (8 females, 5 males); grou p 8, patients who received CT but no pelvic RT (15 females, 25 males); and group C, patients who received CT plus pelvic RT (6 females, 6 males). Resu lts, All patients progressed spontaneously through puberty and evaluable pa tients were found to be sexually mature (Tanner stage IV and V). Serum foll icle stimulating hormone (FSH) was increased in 0/5, 13/25, and 5/6 and tes ticular volume was decreased in 1/3, 4/11, and 2/3 group A, B, and C male p atients, respectively. Leydig cell dysfunction was uncommon; 91% and 88% of males had normal serum concentrations of luteinizing hormone (LH) and test osterone, respectively. FSH and LH were increased in 0/8, 3/15, and 2/6 gro up A, B, and C female patients, respectively, at last follow-up, indicating a 17% prevalence of ovarian dysfunction. Serial data in seven females whos e initial levels of FSH/LH were elevated revealed normalization in four. Si x females delivered eight normal children. Conclusions. The majority of mal es who received CT +/- RT have evidence of germ cell dysfunction, while Ley dig cell function is unaffected in most. In females, although abnormal func tion early after the end of treatment was observed, ovarian function remain ed or returned to normal in most young women. Thus, in females the results of hormone testing performed early after treatment may not be predictive of their eventual reproductive potential. Med. Pediatr. Oncol. 32:366-372, 19 99. (C) 1999 Wiley-Liss, Inc.