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Effect of childhood cancer treatment on fertility markers in adult male long-term survivors

  1. Niels J. van Casteren MD1,
  2. Geert H.M. van der Linden MD, PhD2,
  3. Friederike G.A.J. Hakvoort-Cammel MD2,
  4. Karel Hählen MD, PhD2,
  5. Gert R. Dohle MD, PhD1,
  6. Marry M. van den Heuvel-Eibrink MD, PhD2,*

Article first published online: 25 SEP 2008

DOI: 10.1002/pbc.21780

Issue

Pediatric Blood & Cancer

Pediatric Blood & Cancer

Volume 52, Issue 1, pages 108–112, January 2009

Additional Information

How to Cite

van Casteren, N. J., van der Linden, G. H., Hakvoort-Cammel, F. G., Hählen, K., Dohle, G. R. and van den Heuvel-Eibrink, M. M. (2009), Effect of childhood cancer treatment on fertility markers in adult male long-term survivors. Pediatric Blood & Cancer, 52: 108–112. doi: 10.1002/pbc.21780

Author Information

  1. 1

    Section of Andrology, Department of Urology, Erasmus MC–University Medical Center, Rotterdam, The Netherlands

  2. 2

    Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

*Associate Professor in Pediatric Oncology/Hematology, Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Room Sp-2568, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.

Publication History

  1. Issue published online: 12 NOV 2008
  2. Article first published online: 25 SEP 2008
  3. Manuscript Accepted: 19 AUG 2008
  4. Manuscript Received: 8 MAY 2008

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Keywords:

  • cancer survivors;
  • childhood cancer;
  • fertility;
  • Inhibin B;
  • males

Abstract

Background

Although it is accepted that pediatric cancer treatment harbors a risk of gonadal damage, large cohort studies using up-to-date fertility markers are lacking.

Procedure

The aim of our study was to evaluate the gonadal toxicity of childhood cancer treatment using fertility markers. We included 248 adult male long-term survivors of childhood cancer. Median age at diagnosis: 5 years, median age at follow-up: 24 years, median follow-up time 18 years. We evaluated patient characteristics, treatment modalities, testicular size, and endocrinological parameters including Inhibin B, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone.

Results

The median value of Inhibin B in the cancer survivor group was 126 ng/L versus 177 ng/L in the control group (P < 0.001). In the survivors, 67% had Inhibin B levels below the normal reference value of 150 ng/L compared with 26% in the control group (P < 0.05). Inhibin B was the most sensitive discriminator between survivors and controls. Significantly decreased Inhibin B levels and increased FSH levels were found in men treated for Hodgkin and non-Hodgkin lymphoma, acute-myeloid leukemia, neuroblastoma, and sarcoma as compared to other malignancies. Cumulative dosages of procarbazine and cyclophosphamide were the only independent chemotherapy-related predictors for decrease of Inhibin B levels and increase of FSH. Age at time of treatment did not influence post-treatment Inhibin B or FSH levels.

Conclusions

Severe gonadal impairment is a risk in a considerable subgroup of childhood cancer survivors based on current fertility markers like Inhibin B. Males receiving gonadotoxic treatment before puberty are not protected from post treatment gonadal dysfunction. Pediatr Blood Cancer 2009;52:108–112. © 2008 Wiley-Liss, Inc.

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