Skip to main content

Advertisement

SpringerLink
Log in

Assessment of the ovarian reserve with anti-Müllerian hormone in women who underwent allogeneic hematopoietic stem cell transplantation using reduced-intensity conditioning regimens or myeloablative regimens with ovarian shielding

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Conditioning regimens that include cyclophosphamide (CY) and total body irradiation (TBI) induce severe gonadal toxicity and permanent infertility in approximately 90 % of female patients who undergo hematopoietic stem cell transplantation (HSCT). However, the use of ovarian shielding or non-myeloablative regimens may preserve ovarian function. To evaluate the ovarian reserve, serum anti-Müllerian hormone (AMH) levels were retrospectively measured in 11 female HSCT recipients aged less than 40 years, including seven with acute leukemia (AL) and four with aplastic anemia (AA), who received a myeloablative conditioning regimen with ovarian shielding or a reduced-intensity conditioning regimen. In most patients, menstruation had stopped and AMH level had decreased to an undetectable level (<0.1 ng/ml) after HSCT. Most patients showed a recovery of regular menstruation, but AMH levels did not increase immediately after the resumption of menstruation. However, in three AL patients and two AA patients who were evaluable for long-term recovery, AMH level increased gradually beyond 1 year after HSCT. In conclusion, recovery of the serum AMH level may be delayed after HSCT, and the AMH level early after HSCT may not accurately reflect ovarian reserve. A prospective study is required to address the usefulness of measuring the AMH level in HSCT recipients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Socié G, Salooja N, Cohen A, Rovelli A, Carreras E, Locasciulli A, et al. Nonmalignant late effects after allogeneic stem cell transplantation. Blood. 2003;101(9):3373–85.

    Article  PubMed  Google Scholar 

  2. Sanders JE, Buckner CD, Amos D, Levy W, Appelbaum FR, Doney K, et al. Ovarian function following marrow transplantation for aplastic anemia or leukemia. J Clin Oncol. 1988;6(5):813–8.

    CAS  PubMed  Google Scholar 

  3. Nakagawa K, Kanda Y, Yamashita H, Nakagawa S, Sasano N, Ohtomo K, et al. Ovarian shielding allows ovarian recovery and normal birth in female hematopoietic SCT recipients undergoing TBI. Bone Marrow Transplant. 2008;42(10):697–9.

    Article  CAS  PubMed  Google Scholar 

  4. Lie Fong S, Lugtenburg PJ, Schipper I, Themmen AP, de Jong FH, Sonneveld P, et al. Anti-mullerian hormone as a marker of ovarian function in women after chemotherapy and radiotherapy for haematological malignancies. Hum Reprod. 2008;23(3):674–8.

    Article  CAS  PubMed  Google Scholar 

  5. Al-Qahtani A, Muttukrishna S, Appasamy M, Johns J, Cranfield M, Visser JA, et al. Development of a sensitive enzyme immunoassay for anti-Mullerian hormone and the evaluation of potential clinical applications in males and females. Clin Endocrinol (Oxf). 2005;63(3):267–73.

    Article  CAS  PubMed  Google Scholar 

  6. Seifer DB, Baker VL, Leader B. Age-specific serum anti-Mullerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril. 2011;95(2):747–50.

    Article  CAS  PubMed  Google Scholar 

  7. Rossi BV, Missmer S, Correia KF, Wadleigh M, Ginsburg ES. Ovarian reserve in women treated for acute lymphocytic leukemia or acute myeloid leukemia with chemotherapy, but not stem cell transplantation. ISRN Oncol. 2012;2012:956190.

    PubMed  PubMed Central  Google Scholar 

  8. van Beek RD, van den Heuvel-Eibrink MM, Laven JS, de Jong FH, Themmen AP, Hakvoort-Cammel FG, et al. Anti-Mullerian hormone is a sensitive serum marker for gonadal function in women treated for Hodgkin’s lymphoma during childhood. J Clin Endocrinol Metab. 2007;92(10):3869–74.

    Article  PubMed  Google Scholar 

  9. Bozza C, Puglisi F, Lambertini M, Osa EO, Manno M, Del Mastro L. Anti-Mullerian hormone: determination of ovarian reserve in early breast cancer patients. Endocr Relat Cancer. 2014;21(1):R51–65.

    Article  CAS  PubMed  Google Scholar 

  10. Hamy AS, Porcher R, Cuvier C, Giacchetti S, Schlageter MH, Coussieu C, et al. Ovarian reserve in breast cancer: assessment with anti-Mullerian hormone. Reprod Biomed Online. 2014;29(5):573–80.

    Article  CAS  PubMed  Google Scholar 

  11. Terasako K, Sato K, Sato M, Kimura S, Nakasone H, Okuda S, et al. The effect of different ATG preparations on immune recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia. Hematology. 2010;15(3):165–9.

    Article  CAS  PubMed  Google Scholar 

  12. Oshima K, Kanda Y, Nakasone H, Arai S, Nishimoto N, Sato H, et al. Decreased incidence of acute graft-versus-host disease by continuous infusion of cyclosporine with a higher target blood level. Am J Hematol. 2008;83(3):226–32.

    Article  CAS  PubMed  Google Scholar 

  13. Kanda Y, Mineishi S, Saito T, Saito A, Yamada S, Ohnishi M, et al. Long-term low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001;28(7):689–92.

    Article  CAS  PubMed  Google Scholar 

  14. Asano-Mori Y, Kanda Y, Oshima K, Kako S, Shinohara A, Nakasone H, et al. Long-term ultra-low-dose acyclovir against varicella-zoster virus reactivation after allogeneic hematopoietic stem cell transplantation. Am J Hematol. 2008;83(6):472–6.

    Article  CAS  PubMed  Google Scholar 

  15. Kanda Y, Wada H, Yamasaki R, Kawamura K, Ishihara Y, Sakamoto K, et al. Protection of ovarian function by two distinct methods of ovarian shielding for young female patients who receive total body irradiation. Ann Hematol. 2014;93(2):287–92.

    Article  PubMed  Google Scholar 

  16. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.

    Article  CAS  PubMed  Google Scholar 

  17. Sakata-Yanagimoto M, Kanda Y, Nakagawa M, Asano-Mori Y, Kandabashi K, Izutsu K, et al. Predictors for severe cardiac complications after hematopoietic stem cell transplantation. Bone Marrow Transplant. 2004;33(10):1043–7.

    Article  CAS  PubMed  Google Scholar 

  18. Gleicher N, Weghofer A, Barad DH. Anti-Mullerian hormone (AMH) defines, independent of age, low versus good live-birth chances in women with severely diminished ovarian reserve. Fertil Steril. 2010;94(7):2824–7.

    Article  CAS  PubMed  Google Scholar 

  19. Hovi L, Saarinen-Pihkala UM, Taskinen M, Wikstrom AM, Dunkel L. Subnormal androgen levels in young female bone marrow transplant recipients with ovarian dysfunction, chronic GVHD and receiving glucocorticoid therapy. Bone Marrow Transplant. 2004;33(5):503–8.

    Article  CAS  PubMed  Google Scholar 

  20. Tauchmanovà L, Selleri C, De Rosa G, Esposito M, Orio F, Palomba S, et al. Gonadal status in reproductive age women after haematopoietic stem cell transplantation for haematological malignancies. Hum Reprod. 2003;18(7):1410–6.

    Article  PubMed  Google Scholar 

  21. van Rooij IA, de Jong E, Broekmans FJ, Looman CW, Habbema JD, te Velde ER. High follicle-stimulating hormone levels should not necessarily lead to the exclusion of subfertile patients from treatment. Fertil Steril. 2004;81(6):1478–85.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma, Omiya-ku, Saitama, Saitama, 330-8503, Japan

      Hirofumi Nakano, Masahiro Ashizawa, Yu Akahoshi, Tomotaka Ugai, Hidenori Wada, Ryoko Yamasaki, Yuko Ishihara, Koji Kawamura, Kana Sakamoto, Miki Sato, Kiriko Terasako-Saito, Shun-ichi Kimura, Misato Kikuchi, Hideki Nakasone, Shinichi Kako, Junya Kanda, Rie Yamazaki, Aki Tanihara, Junji Nishida & Yoshinobu Kanda

    Authors
    1. Hirofumi Nakano
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Masahiro Ashizawa
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yu Akahoshi
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Tomotaka Ugai
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Hidenori Wada
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Ryoko Yamasaki
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Yuko Ishihara
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Koji Kawamura
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Kana Sakamoto
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Miki Sato
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Kiriko Terasako-Saito
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Shun-ichi Kimura
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Misato Kikuchi
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Hideki Nakasone
      View author publications

      You can also search for this author in PubMed Google Scholar

    15. Shinichi Kako
      View author publications

      You can also search for this author in PubMed Google Scholar

    16. Junya Kanda
      View author publications

      You can also search for this author in PubMed Google Scholar

    17. Rie Yamazaki
      View author publications

      You can also search for this author in PubMed Google Scholar

    18. Aki Tanihara
      View author publications

      You can also search for this author in PubMed Google Scholar

    19. Junji Nishida
      View author publications

      You can also search for this author in PubMed Google Scholar

    20. Yoshinobu Kanda
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Yoshinobu Kanda.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Additional information

    H. Nakano and M. Ashizawa both authors contributed equally to this work.

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Nakano, H., Ashizawa, M., Akahoshi, Y. et al. Assessment of the ovarian reserve with anti-Müllerian hormone in women who underwent allogeneic hematopoietic stem cell transplantation using reduced-intensity conditioning regimens or myeloablative regimens with ovarian shielding. Int J Hematol 104, 110–116 (2016). https://doi.org/10.1007/s12185-016-1998-y

    Download citation

    • Received:

    • Revised:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s12185-016-1998-y

    Keywords

    Search

    Navigation