This manuscript was originally submitted to and accepted for publication in Medical & Pediatric Oncology by its Editor-in-Chief, Dr. G. D'Angio.
Article first published online: 10 MAR 2004
Copyright © 2004 Wiley-Liss, Inc.
Pediatric Blood & Cancer
Volume 42, Issue 7, pages 589–597, June 2004
How to Cite
Byrne, J., Fears, T. R., Mills, J. L., Zeltzer, L. K., Sklar, C., Nicholson, H. S., Haupt, R., Reaman, G. H., Meadows, A. T. and Robison, L. L. (2004), Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. Pediatr. Blood Cancer, 42: 589–597. doi: 10.1002/pbc.20033
This study was designed and implemented by the National Cancer Institute (NCI) and the National Institute of Child Health and Human Development, NIH, while Dr. Byrne was an NCI staff member.
- Issue published online: 22 APR 2004
- Article first published online: 10 MAR 2004
- Manuscript Accepted: 13 JAN 2004
- Manuscript Received: 12 SEP 2002
- National Cancer Institute
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
- childhood cancer;
Fertility impairments among women treated during childhood for cancer are known to occur after some, but not all, types of anticancer therapy. Although leukemia is the most common cancer of childhood, until now fertility in survivors has not been comprehensively assessed.
We investigated functional impairment of fertility in women who were long-term survivors of acute lymphoblastic leukemia (ALL) with a retrospective cohort study. Proven fertility (defined as ever pregnant) was evaluated by self-report among 182 females treated on protocols of the Children's Cancer Group (age at interview, 22.6 years on average) and 170 controls drawn from among the survivors' female siblings (23.4 years). The interview included psychosocial inventories designed to detect mood problems.
Significant fertility deficits were noted in female survivors treated with cranial radiotherapy (CRT) at any dose around the time of menarche (relative fertility (RF)) = 0.27, 95% CI = 0.09, 0.82, P = 0.03). Controlling for marital status, mood at interview, and many fertility-related situations did not change the association.
This study provides evidence for fertility deficits after treatment for ALL with CRT, and, in addition, for the first time, suggests that girls treated around the time of menarche are especially at risk. Clinical confirmation of these results is needed. If gonadal damage occurs in women receiving these treatments, their risk for further sequelae, such as osteoporosis and heart disease, may be significantly raised, requiring active management and intervention. © 2004 Wiley-Liss, Inc.