325 - Differential effects of stem cell transplant preparative regimens on Anti-Mullerian hormone levels in pediatric cancer patients as an indication of fertility status

Poster Number: 325
Publication Number: 325.113

Thao Trinh, Indiana University School of Medicine, Indianapolis, IN, United States; Mahvish Q. Rahim, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Jodi Skiles, Indiana University School of Medicine, Indianapolis, IN, United States; Amanda Saraf, Amanda Saraf, Indianapolis, IN, United States

Background: With advances in treatments for pediatric cancer there has been an increase in childhood cancer survivors and resulting focus on late term effects of cancer care, including infertility. Preparative regimens used for stem cell transplantation (SCT) place patients at high risk for infertility. Despite this, some women will have an opportunity post-therapy to cryopreserve oocytes before onset of premature ovarian failure, but there is currently no stratification system to determine which patients can reasonably delay fertility sparing procedures until therapy is complete. Levels of anti-Mullerian hormone (AMH), a surrogate indicator of ovarian reserve, may be useful in guiding utility and timing of fertility sparing procedures after exposure to gonadotoxic therapies.

Objective: In this retrospective study, we aimed to evaluate the impact of different SCT preparative regimens on AMH levels.

Design/Methods: We reviewed medical records of 25 patients who underwent SCT between the years of 2010 – 2020 at Riley Hospital for Children. Demographics, treatment regimens, pre and post SCT AMH levels (when available) were recorded.

Results: Of the 25 patients, 22 (88%) had undetectable levels of AMH ( < 0.003 ng/mL) measured at an average of 3 years post SCT (range 3 months – 9 years), indicating decreased potential to successfully undergo oocyte cryopreservation. Three patients (12%) had detectable AMH levels (range 0.2-5.2 ng/mL) post-SCT but did not have pre-SCT AMH levels for comparison. Of the three patients who still had detectable AMH levels post-SCT, two had undergone SCT for aplastic anemia with a preparative regimen of Cytoxan/Anti-Thymocyte Globulin (CED=6g/m2). The third patient had undergone SCT for acute lymphoblastic leukemia with a preparative regimen of total body irradiation (TBI)/Cytoxan (cumulative CED = 6.6g/m2 + 12Gy TBI).Conclusion(s): Our findings suggest that the majority of patients have minimal ovarian reserve post-SCT, such that successful post-transplant oocyte cryopreservation is unlikely. Furthermore, not all SCT preparative regimens may have the same impact on AMH. Future studies with uniform pre/post AMH measurements at regular intervals are needed to determine whether there are some patients who could reasonably delay fertility sparing procedures until after transplant. Since infertility is known to significantly reduce the quality of life for childhood cancer patients, it is important to further stratify the infertility risk based on varying preparative regimens to guide urgency and timing of fertility sparing procedures.