Gonadotropin releasing hormone agonists may minimize cyclophosphamide associated gonadotoxicity in SLE and autoimmune diseases.

Abstract

OBJECTIVE:

Since young women undergoing cyclophosphamide pulse therapy may suffer premature ovarian failure (POF) in almost 50% of cases, we examined the ability of GnRH-a administration to minimize the gonadotoxicity associated with cyclophosphamide pulse therapy (CPT).

METHODS:

Retrospective analysis of medical charts of 44 women (age 16-38 years) who received CPT for autoimmune diseases. In 33 patients a monthly depot injection of GnRH-a was started before the alkylating agent. The ovarian function [spontaneous menstrual bleeding, hormonal profile, (FSH, LH, E(2), progesterone) pelvic sonography, and conceptions] was evaluated, 1 to 10 years after CPT.

RESULTS:

In the GnRH-a group, 30 women resumed cyclic ovarian function; 1 (a 37-year-old patient) developed POF (3%), and 2 were lost to follow-up. In the control (no GnRH-a) group, 5 of 11 patients suffered POF (45%). The mean age in the study group was 25.6 ± 5.2 years compared with 29.3 ± 5.8 years in the control group, and the mean cumulative cyclophosphamide dose was 9.9 g compared to 10.9 g, respectively. The difference in the long-term POF remained significant even after adjusting the groups for comparable age and cumulative cyclophosphamide doses.

CONCLUSION:

GnRH-a decreases cyclophosphamide-associated gonadotoxicity and POF in young women with systemic lupus erythematosus and other autoimmune diseases. Therefore this treatment should be considered and recommended to every young woman before gonadotoxic chemotherapy.

• Authors: Zeev Blumenfeld, Or Mischari, Naomi Schultz, Nina Boulman, Alexandra Balbir-Gurman
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 41 Issue 3 Pg. 346-52 (Dec 2011) ISSN: 1532-866X [Electronic] United States
• PMID: 21868068 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 Elsevier Inc. All rights reserved.

Chemical References

• Antirheumatic Agents
• Immunosuppressive Agents
• Gonadotropin-Releasing Hormone
• Cyclophosphamide

Topics

• Adolescent
• Adult
• Antirheumatic Agents (adverse effects, therapeutic use)
• Autoimmune Diseases (drug therapy)
• Cyclophosphamide (adverse effects, therapeutic use)
• Female
• Gonadotropin-Releasing Hormone (agonists, therapeutic use)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Lupus Erythematosus, Systemic (drug therapy)
• Primary Ovarian Insufficiency (prevention & control)
• Retrospective Studies