COSA:AYA cancer fertility preservation/Impact of cancer treatments on fertility/Table effects amenorrhea

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Fertility preservation for AYAs diagnosed with cancer: Guidance for health professionals. > COSA:AYA cancer fertility preservation/Impact of cancer treatments on fertility/Table effects amenorrhea

Table 2: Effect of cancer treatment on development of amenorrhea [1]

Degree of Risk Treatment Protocol Common Usage
High risk: > 80% of women develop amenorrhea after treatment Whole abdominal or pelvic radiation doses ≥ 6 Gy in adult women Multiple cancers
Whole abdominal or pelvic radiation doses; ≥ 15 Gy in prepubertal girls and ≥ 10 Gy in postpubertal girls Wilms tumor, neuroblastoma, sarcoma, Hodgkin lymphoma
Total body irradiation (TBI) radiation doses (83% risk) [2] Bone marrow transplantation, Stem cell transplantation (BMT/SCT)
CMF, CEF, or CAF × 6 cycles in women age 40+ Breast cancer
Cyclophosphamide 5 g/m2 in women age 40+ Multiple cancers
Cyclophosphamide 7.5 g/m2in females age < 20 NHL, neuroblastoma, ALL, sarcoma
Alkylating chemotherapy (eg, cyclophosphamide, busulfan, melphalan) conditioning for transplantation BMT/SCT
Any alkylating agent (eg, cyclophosphamide, ifosfamide, busulfan, BCNU, CCNU) + TBI or pelvic radiation BMT/SCT, ovarian cancer, sarcoma, neuroblastoma, Hodgkin lymphoma
Protocols containing procarbazine (51% risk) [3]: MOPP, MVPP, COPP, ChIVPP, ChIVPP/EVA, MOPP/ABVD, COPP/ABVD Hodgkin lymphoma
Cranial/brain radiation ≥ 40 Gy Brain tumour
Intermediate risk: approximately 30%-70% of women develop amenorrhea after treatment CMF, CEF, or CAF × 6 cycles in women age 30-39 Breast cancer
AC in women age 40+ Breast cancer
BEACOPP protocol Hodgkin lymphoma
Whole abdominal or pelvic radiation 10 to < 15 Gy in prepubertal girls Wilms tumour, neuroblastoma
Whole abdominal or pelvic radiation 5 to 10 Gy in postpubertal girls, spinal radiation ≥ 25 Gy Spinal tumour, brain tumour, neuroblastoma, relapsed ALL or NHL
Low risk: < 20% of women develop amenorrhea AC in women age 30-39 Breast cancer
CMF, CEF, or CAF × 6 cycles in women age < 30 Breast cancer
Lower dose alkylating chemotherapy: ABVD (5% risk) [4], CHOP(q21), COP (in women aged 30-35) Hodgkin lymphoma, NHL
Anthracycline + cytarabine AML
Multiagent therapies ALL
Very low/no risk: negligible effect on menses Methotrexate + fluorouracil Breast cancer
Vincristine (used in multiagent therapies) Leukaemia, Hodgkin lymphoma, NHL, neuroblastoma, rhabdomyosarcoma, Wilms tumour, Kaposi's sarcoma
Radioactive iodine Thyroid cancer
Unknown risk Paclitaxel, docetaxel (taxanes used in AC protocols) Breast cancer
Oxaliplatin Ovarian cancer
Irinotecan Colon cancer
Bevacizumab Colon, non–small-cell lung cancer
Cetuximab Colon, head and neck cancer
Trastuzumab Breast cancer
Erlotinib Non–small-cell lung, pancreatic cancer
Imatinib Chronic myeloid leukemia, GI stromal tumor

Source: Levine J, Canada A, Stern CJ. Fertility preservation in adolescents and young adults with cancer J Clin Oncol 2010 Nov 10;28(32):4831-41 [Available at http://www.ncbi.nlm.nih.gov/pubmed/20458029].

References

  1. Levine J, Canada A, Stern CJ. Fertility preservation in adolescents and young adults with cancer. J Clin Oncol 2010 Nov 10;28(32):4831-41 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/20458029.
  2. Borgmann-Staudt A, Rendtorff R, Reinmuth S, Hohmann C, Keil T, Schuster FR, et al. Fertility after allogeneic haematopoietic stem cell transplantation in childhood and adolescence. Bone Marrow Transplant 2011 Apr 11 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21478918.
  3. Behringer K, Breuer K, Reineke T, May M, Nogova L, Klimm B, et al. Secondary amenorrhea after Hodgkin's lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin's Lymphoma Study Group. J Clin Oncol 2005 Oct 20;23(30):7555-64 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16234521.
  4. Leader A, Lishner M, Michaeli J, Revel A. Fertility considerations and preservation in haemato-oncology patients undergoing treatment. Br J Haematol 2011 May;153(3):291-308 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21391973.