Anti-Müllerian hormone levels in patients with gestational trophoblastic neoplasia treated with different chemotherapy regimens: a prospective cohort study.

Xiaoning Bi,Jiaxin Yang,Fengzhi Feng,Hengzi Sun,Yang Xiang,Xinqi Cheng,Jingjing Zhang,Dongyan Cao,Xirun Wan,Ling Qiu,Keng Shen

doi:10.18632/oncotarget.23027

Abstract

PurposeTo assess the ovarian reserve of patients with gestational trophoblastic neoplasia (GTN) treated with chemotherapy by evaluating serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels before, during, and after chemotherapy.ResultsThe basal AMH level (mean: 3.98 ± 3.20 ng/mL) negatively correlated with age, while the basal FSH level (mean: 5.71 ± 9.69 mIU/mL) had no correlation with age. After 3 chemotherapy cycles, serum AMH levels decreased and FSH levels increased. The magnitude of the AMH level decline was significantly greater for combination chemotherapy than for single-agent dactinomycin D therapy (61.80% vs. 27.57%) (p = 0.0004) and was higher in patients whose regimens included etoposide (73.69% vs 40.51%) (p = 0.0359). After chemotherapy completion, AMH levels showed a further decline, and cumulative AMH concentration change was associated with doses of vincristine (p = 0.009) and etoposide (p = 0.032). At the 3-month follow-up, AMH levels significantly increased in the dactinomycin D group (p = 0.0067).Materials and MethodsThis prospective study included 34 patients with GTN. Serum AMH and FSH levels were measured before chemotherapy, after the 3rd cycle, and at 2 weeks and 3 months after chemotherapy. Cumulative changes of serum AMH levels in patients who received different chemotherapy regimens were analyzed.ConclusionsChemotherapy for GTN affects the ovarian reserve, with substantial differences between chemotherapy protocols. The results improve our understanding of ovarian toxicity and support the use of fertility preservation strategies.

Highlights

Gestational trophoblastic disease (GTD) comprises a group of disorders in which tumors arise from placental trophoblastic tissue after abnormal fertilization
The magnitude of the anti-Müllerian hormone (AMH) level decline was significantly greater for combination chemotherapy than for single-agent dactinomycin D therapy (61.80% vs. 27.57%) (p = 0.0004) and was higher in patients whose regimens included etoposide (73.69% vs 40.51%) (p = 0.0359)
At the 3-month followup, AMH levels significantly increased in the dactinomycin D group (p = 0.0067)

Summary

Introduction

Gestational trophoblastic disease (GTD) comprises a group of disorders in which tumors arise from placental trophoblastic tissue after abnormal fertilization. The malignant forms of GTD are collectively known as gestational trophoblastic neoplasias (GTNs) and include invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT), and the extremely rare epithelioid trophoblastic tumor [1]. Improvements in management and followup protocols have increased the overall cure rate to over 98% with fertility retention, whereas most women would have died from malignant disease 60 years prior [2]. Chemotherapy agents cause depletion of the primordial follicle pool, affecting ovarian function. This has been demonstrated in breast cancer [3], lymphoma [4], and ovarian germ cell tumors [5]

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Conclusion