Background Systemic lupus erythematosus (SLE) is about 10 times more common in females s and during cytotoxic treatment with cyclophosphamide (CYC) is often used for renal involvement. CYC has significant gonadotoxic effects increasing the risk for primary ovarian insufficiency (POI).
Objectives In this study, we aim to assess symptoms of ovarian failure in females with SLE who underwent CYC therapy and to compare menstrual parameters with SLE patients who did not use CYC previously.
Methods Eighteen female SLE patients with and without prior CYC exposure were included in the study group. The patients had been followed at the Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey. They all received six pulses of IV CYC. The parameters about menstrual cycles and fertility of patients were evaluated retrospectively. SPSS 15.0 for Windows is used for statistical analysis.
Results We enrolled 18 SLE patients, 10 of whom had received CYC therapy previously. Among females with prior CYC exposure (median current age 21 years), the median age at SLE diagnosis was 11 (10-13) years and the median age at initiation of CYC therapy was 11 (10.5-15) years. All had received CYC intravenously with a median cumulative dose of 94 (62-109) mg/kg. Six out of 10 patients had received CYC before menarche. Only one patient had irregular menses after CYC therapy; she had a cumulative dose of 95 mg/kg and CYC was given to her three years before menarch. In the control group (n=7), the median age at SLE diagnosis was 11.5 (9-17.5) years and median current age was 18.25 (14.5-24) years. One patient in the control group also had irregular menses. The patients were interviewed median 10 years (2-14.5) years later. Two pregnancies were reported, one (live birth) in CYC group and the other one (however resulted in abortus) in the control group. There was no significant difference between two groups according to the current age, age at SLE diagnosis, age at menarche, regularity of menses, and number of pregnancies.
Conclusions In our study there was no significant difference between two groups of SLE patients (CYC versus CYC-naïve). Previous studies have shown the cumulative dose of CYC and patient age at initiation of CYC therapy determine ovarian toxicity. The young age at onset of CYC therapy in our patients (which is before menarche in six) may be the factor limiting the extent of ovarian damage.
Harward LE, Mitchell K, Pieper C, et al. The impact of cyclophosphamide on menstruation and pregnancy in women with rheumatologic disease. Lupus 2013;22(1):81-6.
Marder W, Fisseha S, Ganser MA, Somers EC. Ovarian Damage During chemotherapy in Autoimmune Diseases: Broad Health Implications beyond Fertility. Clin Med Insights Reprod Health 2012;2012(6):9-18.
Disclosure of Interest None declared