Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia

Julianne Byrne, Thomas R. Fears, James L. Mills, Lonnie K. Zeltzer, Charles Sklar, H. Stacy Nicholson, Riccardo Haupt, Gregory H. Reaman, Anna T. Meadows, Leslie L. Robison

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background. 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. Procedure. 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. Results. 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. Conclusion. 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.

Original languageEnglish (US)
Pages (from-to)589-597
Number of pages9
JournalPediatric Blood and Cancer
Volume42
Issue number7
DOIs
StatePublished - Jun 2004

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Fertility
Radiotherapy
Survivors
Menarche
Interviews
Neoplasms
Marital Status
Self Report
Osteoporosis
Siblings
Heart Diseases
Leukemia
Cohort Studies
Therapeutics
Retrospective Studies
Age Groups
Equipment and Supplies

Keywords

  • Childhood cancer
  • Fertility
  • Leukemia
  • Menarche
  • Radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Byrne, J., Fears, T. R., Mills, J. L., Zeltzer, L. K., Sklar, C., Nicholson, H. S., ... Robison, L. L. (2004). Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. Pediatric Blood and Cancer, 42(7), 589-597. https://doi.org/10.1002/pbc.20033

Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. / Byrne, Julianne; Fears, Thomas R.; Mills, James L.; Zeltzer, Lonnie K.; Sklar, Charles; Nicholson, H. Stacy; Haupt, Riccardo; Reaman, Gregory H.; Meadows, Anna T.; Robison, Leslie L.

In: Pediatric Blood and Cancer, Vol. 42, No. 7, 06.2004, p. 589-597.

Research output: Contribution to journalArticle

Byrne, J, Fears, TR, Mills, JL, Zeltzer, LK, Sklar, C, Nicholson, HS, Haupt, R, Reaman, GH, Meadows, AT & Robison, LL 2004, 'Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia', Pediatric Blood and Cancer, vol. 42, no. 7, pp. 589-597. https://doi.org/10.1002/pbc.20033
Byrne, Julianne ; Fears, Thomas R. ; Mills, James L. ; Zeltzer, Lonnie K. ; Sklar, Charles ; Nicholson, H. Stacy ; Haupt, Riccardo ; Reaman, Gregory H. ; Meadows, Anna T. ; Robison, Leslie L. / Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. In: Pediatric Blood and Cancer. 2004 ; Vol. 42, No. 7. pp. 589-597.
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abstract = "Background. 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. Procedure. 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. Results. 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. Conclusion. 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.",
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