Variables associated with ovarian insufficiency in pediatric oncology patients following chemotherapy

Purpose: Gonadotoxic effects of chemotherapy is a critical concern in Pediatric Oncology given most patients survive their cancer. Future fertility is an important concern in this population supporting the need for additional research on chemotherapy gonadotoxicity. This study’s purpose was to identify associations with premature ovarian insufficiency (POI) in pediatric patients with a history of cancer based on age, cancer type and cyclophosphamide equivalent dose (CED). Methods: We retrospectively collected data on pediatric patients with cancer treated between 2008–2017. Inclusion criteria included female gender, age 0–25 at time of cancer diagnosis, diagnosis of a malignancy requiring chemotherapy, and documented ovarian hormone levels following chemotherapy completion. Results: Two-hundred and forty-five female patients were identified based on age, malignancy and chemotherapy criteria.. Of these, 57 had documented ovarian hormone levels following chemotherapy. Five patients (9%) met criteria for POI. These 5 patients were all ≥ 13 years old at time of cancer diagnosis and found to have a lymphoma or solid tumor diagnosis. Conclusion: We sought to analyze ovarian hormone levels for pediatric cancer survivors based on age in which chemotherapy was administered. There was a significant association between POI and age ≥ 13 years at time of cancer diagnosis. Those documented with POI received a CED between 0-28.4 gm/m 2 , suggesting other factors contribute to ovarian dysfunction. Implications for cancer survivors As more pediatric patients are being cured of their cancer diagnoses, gonadal health and treatment-related risks continue to be important topics of research to help provide informed gonadal-preservation conversations in this vulnerable population.