Teinturier C, Hartmann O, Valteau-Couanet D, Benhamou E, Bougneres P F
Department of Pediatric Endocrinology, Hopital Saint-Vincent de Paul, Paris, France.
Bone Marrow Transplant. 1998 Nov;22(10):989-94. doi: 10.1038/sj.bmt.1701483.
We studied pubertal status and ovarian function in 21 girls aged 11-21 years who had earlier received 1.2-13 years (median 7 years) high-dose chemotherapy and autologous BMT without TBI for malignant tumors. Ten of them were given busulfan (600 mg/m2) and melphalan (140 mg/m2) with or without cyclophosphamide (3.6 g/m2). Eleven others did not receive busulfan. Twelve girls (57%) had clinical and hormonal evidence of ovarian failure. Among nine others who had completed normal puberty, six had normal gonadotropin levels, one had elevated gonadotropin levels and two had gonadotropin levels at the upper limit of normal. The 10 girls who received busulfan all developed severe and persistent ovarian failure. High-dose busulfan is therefore a major cause of ovarian failure even when given in the prepubertal period. These findings emphasize the need for long-term endocrine follow-up of these patients in order to initiate estrogen replacement therapy.
我们研究了21名年龄在11至21岁的女孩的青春期状态和卵巢功能，这些女孩曾在1.2至13年（中位数7年）前接受过针对恶性肿瘤的高剂量化疗及自体骨髓移植，未接受全身照射。其中10名女孩接受了白消安（600mg/m²）和马法兰（140mg/m²）治疗，部分联合或未联合环磷酰胺（3.6g/m²）。另外11名女孩未接受白消安治疗。12名女孩（57%）有卵巢功能衰竭的临床和激素证据。在另外9名已完成正常青春期发育的女孩中，6名促性腺激素水平正常，1名促性腺激素水平升高，2名促性腺激素水平处于正常上限。接受白消安治疗的10名女孩均出现了严重且持续的卵巢功能衰竭。因此，即使在青春期前给予高剂量白消安，也是卵巢功能衰竭的主要原因。这些发现强调了对这些患者进行长期内分泌随访以便启动雌激素替代治疗的必要性。
