Hovi L, Saarinen-Pihkala U M, Taskinen M, Wikström A M, Dunkel L
Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Bone Marrow Transplant. 2004 Mar;33(5):503-8. doi: 10.1038/sj.bmt.1704376.
Ovarian function and sex hormone production with special focus on androgens (testosterone, androstenedione, dehydroepiandrosterone and its sulfate, DHEAS) was followed up during 1.5-20 (mean 9) years after bone marrow transplantation (BMT) in 24 female subjects aged 16-33 (mean 21) years at the last follow-up. All patients had received TBI and high-dose chemotherapy as the preparative regimen. A total of 24 female patients with conventionally treated pediatric hematologic malignancies served as controls. Four of 24 transplanted patients had spontaneous menstruation several years post transplantation, but in only one of them were serum FSH levels normal. Androgen levels of the BMT patients were lower than those of the conventionally treated patients. Subnormal testosterone levels were observed in 43% of BMT patients and subnormal DHEAS levels in 34% of BMT patients, the latter being a constant finding during glucocorticoid therapy for chronic GVHD (cGVHD). These results indicate that ovarian damage is a common late effect in patients transplanted at a young age, still having a seemingly normal pubertal development. Ovarian damage and cGVHD with glucocorticoid therapy are strongly associated with subnormal androgen levels. The clinical consequences of these changes and possible benefits of putative androgen replacement therapy remain to be elucidated.
对24名年龄在16 - 33岁（末次随访时平均年龄21岁）的女性受试者进行了随访，观察她们在骨髓移植（BMT）后1.5 - 20年（平均9年）期间的卵巢功能和性激素分泌情况，特别关注雄激素（睾酮、雄烯二酮、脱氢表雄酮及其硫酸盐，DHEAS）。所有患者均接受了全身照射（TBI）和大剂量化疗作为预处理方案。共有24例接受传统治疗的小儿血液系统恶性肿瘤女性患者作为对照。24例移植患者中有4例在移植后数年出现自发月经，但其中只有1例血清促卵泡激素（FSH）水平正常。BMT患者的雄激素水平低于传统治疗患者。43%的BMT患者睾酮水平低于正常，34%的BMT患者DHEAS水平低于正常，后者是慢性移植物抗宿主病（cGVHD）糖皮质激素治疗期间的持续表现。这些结果表明，卵巢损伤是年轻患者移植后的常见晚期效应，这些患者青春期发育看似正常。卵巢损伤和cGVHD伴糖皮质激素治疗与雄激素水平低于正常密切相关。这些变化的临床后果以及假定的雄激素替代疗法的潜在益处仍有待阐明。
