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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 Transplantation volume 55, pages 1985–1995 (2020)Cite this article

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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.

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Fig. 1: Flow diagram of patient recruitment.
Fig. 2: Comparative AMH standard deviation scores (SDS) in females treated with three differing-intensity conditioning regimens.
Fig. 3: Comparative Inhibin B standard deviation scores (SDS) in males treated with three differing-intensity conditioning regimens.

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Acknowledgements

We thank the Great Ormond Street Hospital Childrens’ Charity (GOSHCC) who funded Dr Alison Leiper on a research grant, to make this research possible. Also thanks to Professor Yolanda de Rijke, head of the department of clinical chemistry, Erasmus MC, Netherlands and to Dr Helen Aitkenhead heading the clinical chemistry laboratory at GOSH, London, UK for ensuring the timely assay of AMH and Inhibin B samples. This work is supported by a grant (W1091) from the Great Ormond Street Hospital Childrens’ Charity.

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Authors and Affiliations

  1. Department of Haematology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK

    Alison Leiper

  2. Department of Pediatric Hematology, Erasmus University Medical Centre - Sophia Children’s Hospital, 3015 CN, Rotterdam, Netherlands

    Maite Houwing

  3. Department of Blood and Marrow Transplantation, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK

    E. Graham Davies & Kanchan Rao

  4. Department of Immunology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, WC1N 3JH, UK

    E. Graham Davies

  5. Department Immunology, UCL Institute of Immunity & Transplantation, Department of immunology, Royal Free Hospital NHS Foundation Trust, Pond Street, London, NW3 2QG, UK

    Siobhan Burns & Emma Morris

  6. Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Erasmus Medical Centre – University Medical Center, Rotterdam, Netherlands

    Joop Laven & Anne-Lotte van der Kooi

  7. Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands

    Marry van den Heuvel Eibrink

  8. Department of Molecular and Clinical Sciences, St George’s University of London, Cranmer Terrace, London, SW17 0RE, UK

    Stephen Nussey

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Leiper, A., Houwing, M., Davies, E.G. et al. 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 55, 1985–1995 (2020). https://doi.org/10.1038/s41409-020-0866-9

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