Alkylating agents, radiotherapy associated with premature ovarian insufficiency
Ovarian radiotherapy at any dose and high-dose alkylating agents appear to be risk factors for premature ovarian insufficiency (POI), suggests a recent study.
POI, defined by persistent amenorrhoea combined with a follicle-stimulating hormone level >30 IU/L, contributes to poor general health outcomes in childhood cancer survivors, according to researchers.
A cross-sectional study of an established cohort (St. Jude Lifetime Cohort) in a tertiary care centre was conducted to describe the prevalence of POI, its risk factors and associated long-term adverse health outcomes. A total of 921 participants (median age 31.7 years) were assessed at a median of 24.0 years after cancer diagnosis.
Researchers used multivariable Cox regression to study associations between demographic or treatment-related risk factors and POI, and multivariable logistic regression to investigate associations between POI and markers for cardiovascular disease, bone mineral density (BMD) and frailty. The validated cyclophosphamide equivalent dose (CED) was used to quantify exposure to alkylating agents.
There was a 10.9-percent prevalence of POI. Ovarian radiotherapy at any dose and CED ≥8,000 mg/m2 were independent risk factors for POI. Participants with a body mass index ≥30 kg/m2 at the time of the St. Jude Lifetime Cohort assessment were less likely to have a diagnosis of POI.
Furthermore, frailty as well as low BMD were independently associated with POI.
Fertility preservation should be provided to patient at the highest risk whenever feasible, according to researchers, adding that further studies are warranted to examine the role of sex hormone replacement in improving outcomes.