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[Changes in gonadal function in post-pubertal male survivors of acute lymphoblastic leukemia and Hodgkin's disease].

AIM
To study gonadal function in male patients surviving acute lymphoblastic leukemia (ALL) or Hodgkins disease (HD).


PATIENTS AND METHODS
Thirteen postpubertal males were studied (Tanner stage V), 9 with ALL and 4 with HD, who had received polychemotherapy during the pre-puberal period. The control group was composed of 13 male volunteers of similar ages and with complete pubertal development. Testicular size, spermiogram, serum levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) before and after stimulus with gonadotropin-releasing hormone (GnRH), and serum testosterone levels were determined. The germinal epithelium was believed to be damaged when at least one of the following criteria was present: 1) oligospermia/azoospermia, 2) increase in serum FSH levels before or after GnRH, or 3) reduction in testicular volume. Lesions in Leydig's cells were thought to exist when serum testosterone levels were reduced or when serum LH levels, before or after stimulus, increased.


RESULTS
Patients with HD presented clear alterations in germinal function and, to a lesser degree, in the function of Leydig's cells. Significant differences compared with the control group (p < 0.001) were found in peak FSH (19.7 +/- 18 vs 4.8 +/- 1.8 microUI/mL), peak LH (49.2 +/- 31 vs 33.4 +/- 10.0 microUI/mL), serum testosterone (4.1 +/- 0.6 vs 5.9 +/- 0.3 ng/mL) and testicular volume (16.6 +/- 2.8 vs 22.5 +/- 2.4 mL). Of the four patients with HD, three presented azoospermia and one oligospermia. No significant differences in any of the clinical or biochemical parameters studied were found in patients surviving ALL compared with the control group, but two of the nine patients studied presented oligospermia.


CONCLUSIONS
The chemotherapy protocols used in the treatment of HD and ALL produced a high incidence of germinal cell damage and subclinical alterations in the Leydig's cell function in males with HD. In patients with ALL, the germinal line was only mildly affected. Prepubertal state does not protect the testes from the harmful effects of chemotherapy.