Do anti-mullerian hormone levels predict ovarian reserve in SLE patients presenting for hematopoietic stem cell transplant?

Abstract

To assess the use of anti-mullerian hormone as a predictor of ovarian function in SLE patients undergoing non-myeolabalative, autologous hematopoietic stem cell transplantation. Retrospective analysis from a phase II study. Six patients with systemic lupus erythematosis (SLE), 4 with Stage IV lupus nephritis and 2 with CNS lupus, were evaluated at the NIH as part of a non-myeloablative, autologous hematopoietic stem cell transplant (HSCT) protocol for refractory disease between January 2004 and October 2006. Prior to the transplantation, all patients received a conditioning regimen of methylprednisolone, cyclophosphamide, fludarabine, and rituximab. Records were reviewed and information was abstracted for menstrual and reproductive history, the use of hormonal medications prior to HSCT, and number of cycles of cyclophosphamide. Measures of ovarian reserve included age, menstrual function, FSH, estradiol, and AMH levels measured at baseline, 4, and 6–9 months post-treatment. The mean number of cycles of IV cyclophosphamide prior to HSCT was 14. Two patients 31 years of age had FSH levels in the menopausal range prior to HSCT. Patients who were amenorrheic and had somatic symptoms consistent with ovarian failure had low AMH levels. One patient, who developed amenorrhea, had normal FSH levels in the presence of low AMH levels. Two patients, who had spontaneous menses and normal FSH levels, demonstrated a reduction in AMH levels from baseline. The use of anti-mullerian hormone in patients undergoing chemotherapy and HSCT may facilitate earlier identification of decreasing ovarian reserve compared to our traditional markers of ovarian function.