Persistent altered spermatogenesis in long-term childhood cancer survivors.

This study evaluated male gonadal function in long-term survivors of childhood cancer and assessed the suitability of offering sperm analysis to all those patients independently of the diagnosis and treatment received. A total of 43 survivors of acute lymphoblastic leukemia (21), acute myeloid leukemia (1), neuroblastoma (8), ganglioneuroblastoma (1), ganglioneuroma (2), Wilms' tumor (9), and mesoblastic nephroma (1) underwent sperm analysis at a mean age of 20.2 years, after a mean time off treatment of 13.6 years. Eight of the patients (19%) were azoospermic, 2 (5%) were severely oligo-asthenozoospermic, and only 16 (37%) were normozoospermic. A control group of healthy volunteers aged < or = 30 years included no azoospermic subjects, 7% severely oligo-asthenozoospermic, and 67% normozoospermic. Comparisons were also made with patients treated at our Human Reproductive Unit aged < or = 30 years (n = 373) whose percentages for the above parameters were 4, 9, and 42%, respectively. Cumulated cyclophosphamide dose and basal follicle-stimulating hormone (FSH) levels were identified as independent factors associated with azoospermia or severe oligo-asthenozoospermia. Azoospermic and severely oligo-asthenozoospermic survivors had significantly smaller mean testicular volume and higher basal FSH levels than the other survivors, but small testicles (sum of both testicular volume < or = 20 mL) and/or abnormally high basal FSH (> 10 mIU/mL) were present in only half of the azoospermic survivors. Male long-term survivors of childhood cancer constitute a high-risk subpopulation for altered sperm analysis. It seems justified to offer sperm analysis to all long-term survivors.

[A comparative study of the weight-height development of the long-term survivors of acute leukemia and solid tumors]. / Estudio comparativo del desarrollo pondoestatural de los supervivientes a largo plazo de leucemia aguda y tumores sólidos.

OBJECTIVE: Our objectives were to analyze the final height and nutritional status in survivors of childhood cancer, their evolution since diagnosis and to identify neoplasm- and/or therapy-related differences. PATIENTS AND METHODS: A survey of long-term survivors of childhood cancer (acute leukemia, Wilms' tumor, sympathetic nervous system tumors) diagnosed before 15 years of age and between 1971 and 1985 in a single tertiary care center was performed. Final height, target height and body mass index were measured at evaluation. Height and body mass index, at diagnosis and at the end of treatment, was retrieved from their clinical records. All parameters are expressed as standard deviation scores of the mean of the population reference. Survivors were grouped according to diagnosis and type of treatment. Comparisons between groups and within each group were made at the time of diagnosis, at the end of treatment and at the time of evaluation. RESULTS: Sixty-one survivors of acute leukemia and 62 of solid tumors were included (32 Wilms' tumors, 20 neuroblastomas, 4 ganglioneuroblastomas and 6 ganglioneuromas). Eighty survivors had attained final height at the time of evaluation and their target height was available. Fourteen had at least one relapse. The mean height standard deviation score was positive at diagnosis and negative at the time of evaluation in all groups. Mean height loss ranged from -0.84 for the non-irradiated acute leukemia group to -1.34 for the non-irradiated solid tumor group. Adjusted final height for target height showed stature loss only in irradiated groups. Height loss was equivalent in cranially irradiated survivors (-0.32 after 18 Gy, -0.34 after 24-25.5 Gy). The age at menarche correlated negatively with the dose of cranial radiotherapy (r = -0.6, p = 0.002) and positively with stature loss (r = 0.5, p = 0.006). The mean body mass index standard deviation score was negative at diagnosis and positive at the time of evaluation in all groups. Twenty percent of solid tumor survivors and 12.5% of acute leukemia survivors were malnourished at diagnosis. Nutritional status improved in all groups at the time of evaluation. Obesity was more frequent in those who received cranial radiotherapy (14%) or intensified therapy (21%) compared with those non-cranially irradiated (none) or whose therapy was less intense (9%). CONCLUSIONS: Most survivors of childhood cancer attained their target height. Stature loss was related to cranial radiotherapy in acute leukemia survivors and to spinal irradiation in solid tumor survivors. At diagnosis, malnourishment was more frequent in solid tumor patients, while at the time of evaluation obesity was associated with a more intensified therapy.