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Cranial irradiation does not result in pituitary–gonadal axis dysfunction in very long-term male survivors of childhood acute lymphoblastic leukemia

Leukemia volume 23, pages 2310–2313 (2009)Cite this article

Currently, >75% of all pediatric acute lymphoblastic leukemia (ALL) patients survive and reach adulthood.1 Successful treatment of children with ALL involves administration of multi-agent chemotherapy and includes central nervous system prophylaxis. In the past, central nervous system prophylaxis consisted of cranial irradiation, which has been replaced by intrathecal chemotherapy in most current treatment protocols. An increasing cohort of childhood ALL survivors who have been treated with cranial radiotherapy in the past has now reached reproductive age. It has been reported that cranial irradiation can influence the hypothalamic–pituitary–gonadal axis and potentially lead to impaired endocrine function resulting in growth disturbances and impaired fertility.2, 3

Earlier fertility studies in pediatric ALL survivors were mainly based on pituitary hormone level measurement or on registration of life birth rates and did not include novel markers like Inhibin B.4 Inhibin B is produced by the Sertoli cells and is strongly correlated with sperm characteristics and fertility capacity in men and also correlates with spermatogenic status in testicular biopsies.5, 6 Inhibin B has a negative feedback mechanism with follicle-stimulating hormone (FSH), and it has been shown to be a good marker for testicular damage after chemotherapy.7, 8, 9

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Authors and Affiliations

  1. Department of Urology, Section of Andrology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands

    N J van Casteren & G R Dohle

  2. Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands

    R Pieters, M van Baalen, S Neggers & M M van den Heuvel-Eibrink

  3. Department of Internal Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, The Netherlands

    S Neggers

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  1. N J van Casteren
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  2. R Pieters
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  4. M van Baalen
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  6. M M van den Heuvel-Eibrink
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Correspondence to M M van den Heuvel-Eibrink.

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van Casteren, N., Pieters, R., Dohle, G. et al. Cranial irradiation does not result in pituitary–gonadal axis dysfunction in very long-term male survivors of childhood acute lymphoblastic leukemia. Leukemia 23, 2310–2313 (2009). https://doi.org/10.1038/leu.2009.165

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