Hassel J U, Brämswig J H, Schlegel W, Schellong G
Universitäts-Kinderklinik, Münster.
Klin Padiatr. 1991 Jul-Aug;203(4):268-72. doi: 10.1055/s-2007-1025440.
Gonadal function was evaluated in 25 boys treated for Hodgkin's disease according to the DAL-HD-85 protocol with OPA- or OPA/COMP-chemotherapy (vincristine-prednisone-adriamycine/cyclophosphamide-vincristine-m ethotrexate- prednisone). All boys were in first continuous complete remission for 6 to 45 months at chronological ages varying from 14.0 to 18.9 years. Testosterone, basal and GnRH-stimulated LH- and FSH-levels were measured. Gonadal function was normal in 16 patients treated with 2 cycles of OPA-chemotherapy in Hodgkin stages I-IIA. 9 patients were treated with 2 OPA- and 2 or 4 COMP-cycles of chemotherapy and had received mean cyclophosphamide doses ranging from 2004 to 3722 mg/m2. Again, no major testicular damage was noted, though some patients had increased stimulated LH-levels possibly indicating compensated Leydig cell-insufficiency. Our results demonstrate, that testicular function is not severely affected when patients are treated for Hodgkin's disease without procarbazine even if cyclophosphamide is given in cumulative doses below 3800 mg/m2. The previously documented severe testicular damage in boys treated according to the DAL-studies HD-78 and HD-82 is thus a result of the gonadotoxic action of procarbazine.
根据DAL-HD-85方案，采用OPA或OPA/COMP化疗（长春新碱-泼尼松-阿霉素/环磷酰胺-长春新碱-甲氨蝶呤-泼尼松）对25例霍奇金病男孩的性腺功能进行了评估。所有男孩年龄在14.0至18.9岁之间，处于首次持续完全缓解状态6至45个月。测量了睾酮、基础及GnRH刺激后的LH和FSH水平。16例霍奇金病I-IIA期接受2周期OPA化疗的患者性腺功能正常。9例患者接受了2周期OPA和2或4周期COMP化疗，平均环磷酰胺剂量为2004至3722mg/m²。同样，尽管部分患者刺激后的LH水平升高，可能提示代偿性睾丸间质细胞功能不全，但未发现严重睾丸损害。我们的结果表明，即使环磷酰胺累积剂量低于3800mg/m²，在不使用丙卡巴肼治疗霍奇金病时，睾丸功能不会受到严重影响。因此，之前DAL研究HD-78和HD-82中记录的男孩严重睾丸损害是丙卡巴肼性腺毒性作用的结果。
