Reproductive Endocrinology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Semin Arthritis Rheum. 2011 Dec;41(3):346-52. doi: 10.1016/j.semarthrit.2011.05.008. Epub 2011 Aug 24.
Since young women undergoing cyclophosphamide pulse therapy may suffer premature ovarian failure (POF) in almost 50% of cases, we examined the ability of GnRH-a administration to minimize the gonadotoxicity associated with cyclophosphamide pulse therapy (CPT).
Retrospective analysis of medical charts of 44 women (age 16-38 years) who received CPT for autoimmune diseases. In 33 patients a monthly depot injection of GnRH-a was started before the alkylating agent. The ovarian function [spontaneous menstrual bleeding, hormonal profile, (FSH, LH, E(2), progesterone) pelvic sonography, and conceptions] was evaluated, 1 to 10 years after CPT.
In the GnRH-a group, 30 women resumed cyclic ovarian function; 1 (a 37-year-old patient) developed POF (3%), and 2 were lost to follow-up. In the control (no GnRH-a) group, 5 of 11 patients suffered POF (45%). The mean age in the study group was 25.6 ± 5.2 years compared with 29.3 ± 5.8 years in the control group, and the mean cumulative cyclophosphamide dose was 9.9 g compared to 10.9 g, respectively. The difference in the long-term POF remained significant even after adjusting the groups for comparable age and cumulative cyclophosphamide doses.
GnRH-a decreases cyclophosphamide-associated gonadotoxicity and POF in young women with systemic lupus erythematosus and other autoimmune diseases. Therefore this treatment should be considered and recommended to every young woman before gonadotoxic chemotherapy.
由于接受环磷酰胺冲击治疗的年轻女性几乎有 50%会发生卵巢早衰（POF），因此我们研究了 GnRH-a 给药以最大程度降低与环磷酰胺冲击治疗（CPT）相关的性腺毒性的能力。
对 44 名接受 CPT 治疗自身免疫性疾病的女性（年龄 16-38 岁）的病历进行回顾性分析。在 33 例患者中，在使用烷化剂前每月给予 GnRH-a depot 注射。在 CPT 后 1-10 年，评估卵巢功能[自发性月经出血、激素谱（FSH、LH、E2、孕激素）、盆腔超声和妊娠]。
在 GnRH-a 组中，有 30 名女性恢复了周期性卵巢功能；1 名（37 岁患者）发生 POF（3%），2 名失访。在对照组（未使用 GnRH-a）中，11 名患者中有 5 名发生 POF（45%）。研究组的平均年龄为 25.6 ± 5.2 岁，对照组为 29.3 ± 5.8 岁，累积环磷酰胺剂量分别为 9.9 g 和 10.9 g。即使在调整了年龄和累积环磷酰胺剂量相似的两组后，长期 POF 的差异仍然显著。
在患有系统性红斑狼疮和其他自身免疫性疾病的年轻女性中， GnRH-a 可降低环磷酰胺相关的性腺毒性和 POF。因此，在性腺毒性化疗前，应考虑并向每位年轻女性推荐这种治疗方法。
