Effect of the gonadotropin-releasing hormone antagonist cetrorelix on the prevention of chemotherapy-induced ovarian damage in women with hematological malignancy

Abstract

Gonadotropin-releasing hormone (GnRH) agonists are the most commonly used pharmaceutical treatment for ovarian protection during chemotherapy [1,2]. A recent study showed that a combination of GnRH agonists and antagonists induced a long-lasting suppression of gonadotropins but did not completely prevent flare-up of follicle stimulating hormone [3]. The aim of the present study was to evaluate the use of cetrorelix, a GnRH antagonist, for prevention of ovarian damage during chemotherapy in patients with a hematologic malignancy, such as Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), and acute leukemia (AL). The study included 24 women (mean age at diagnosis, 23.3± 6.4 years) who had been diagnosed with a hematologic malignancy (15 HL, 4 NHL, and 5 AL). All patients received chemotherapy with various cytotoxic agents, including cyclophosphamide, and 3 mg of cetrorelix subcutaneously every second day. Data were compared retrospectively with 31 women (mean age, 26.4±6.2 years) who had been diagnosed with a hematologic cancer (18 HL, 12 NHL, and 3 AL) and received the same chemotherapy, but without cetrorelix. The study was approved by the Institutional Review Board. Pb0.05 was considered significant at statistical analysis. Among the 23 evaluable women (1 died) who received cetrorelix, the incidence of secondary amenorrhea 6 months after cessation of treatment was significantly lower compared with the women who did not receive cetrorelix (4.3% vs 27.3%, P=0.036; Table 1). No significant differences were observed between the 2 groups in the mean serum levels of follicle-stimulating hormone, estradiol, and anti-Mullerian hormone after completion of chemotherapy (P>0.05; Table 1), suggesting a degree of ovarian damage despite cetrorelix administration.