Anti-Müllerian hormone and Inhibin B after stem cell transplant in childhood: a comparison of myeloablative, reduced intensity and treosulfan-based chemotherapy regimens

Bone Marrow Transplant. 2020 Oct;55(10):1985-1995. doi: 10.1038/s41409-020-0866-9. Epub 2020 Mar 30.

Abstract

Serum concentrations of Anti-Müllerian hormone (AMH) and Inhibin B were used to assess potential fertility in survivors of childhood haematopoietic stem cell transplantation (HSCT) after three chemotherapy-conditioning regimens of differing intensity. Of 428 patients transplanted between 1990-2012 for leukaemia and immunodeficiency 121 surviving >1 year after a single HSCT were recruited. Group A had a treosulfan-based regimen (low-toxicity); Group B had fludarabine/melphalan (Flu-Mel) (reduced-intensity) and Group C had busulphan/cyclophosphamide (Bu-Cy) (myelo-ablative). Mean age at HSCT and follow-up and length of follow-up were 3.6, 11.8 and 9.9 years. Mean AMH standard deviation scores (SDS) were significantly higher in Group A (-1.047) and Group B (-1.255) than Group C (-1.543), suggesting less ovarian reserve impairment after treosulfan and Flu-Mel than after Bu-Cy. Mean serum AMH concentration was significantly better with treosulfan (>1.0 μg/l) than with Flu-Mel or Bu-Cy. In males, mean Inhibin B SDS was significantly higher in Group A (-0.506) than in Group B (-2.53) and Group C (-1.23) with the Flu-Mel group suffering greatest impairment. In conclusion, a treosulfan-based regimen confers a more favourable outlook for gonadal reserve than Flu-Mel or Bu-Cy in both sexes. Higher values of Inhibin B after Bu-Cy than after Flu-Mel may reflect recovery over time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Mullerian Hormone* / therapeutic use
  • Busulfan* / analogs & derivatives
  • Child
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Inhibins* / therapeutic use
  • Male
  • Stem Cell Transplantation
  • Transplantation Conditioning / adverse effects
  • Vidarabine

Substances

  • inhibin B
  • Inhibins
  • Anti-Mullerian Hormone
  • treosulfan
  • Vidarabine
  • Busulfan