Nancy E Hood, Lindsey Turner, Natalie Colabianchi, Frank J Chaloupka, Lloyd D Johnston
Availability of drinking water in US public school cafeterias
Journal of the Academy of Nutrition and Dietetics
impact euronetphlc2 treatment protocol children classical hodgkin lymphoma chl gonadal function girls based assessment serum antimllerian hormone amh serum amh levels decreased induction chemotherapy increased subsequent treatment 2 years followup lowest levels patients treated advanced stage chl treatment chl particularly alkylating agents pelvic irradiation gonadotoxic result premature reduction primordial follicles females current euronetphlc2 trial aims reduce use radiotherapy standard childhood chl treatment intensifying chemotherapy study aims assess gonadotoxic effect euronetphlc2 protocol international prospective multicenter cohort study embedded euronetphlc2 trial european phase3 treatment study evaluating efficacy standard chl treatment oepacopdac28 oepa vincristine etoposide prednisone doxorubicin copdac28 cyclophosphamide vincristine prednisone dacarbazine versus intensified oepadecopdac21 decopdac21 copdac additional doxorubicin etoposide 25 cyclophosphamide randomized setting participants recruited january 2017 september 2021 female patients aged 18 years treated according euronetphlc2 protocol chl recruited across 18 sites netherlands belgium germany austria czech republic parents patients aged 12 years old provided written informed consent serum amh levels menstrual cycle characteristics evaluated time diagnosis one three times treatment 2 5 years postdiagnosis compared treatmentlevels tl1 tl2 tl3 treatmentarms oepacopdac28 oepadecopdac21 serum samples obtained patients receiving pelvic radiotherapy excluded main analyses total 104 females median age diagnosis 156 years iqr 137 170 included analysis ninetynine postpubertal eighteen girls diagnosed early stage chl tl1 86 intermediate advanced stage disease 50 tl2 36 tl3 66 received copdac28 34 decopdac21 five patients received pelvic radiotherapy median amh level diagnosis 17 gl iqr 09 27 two courses oepa chemotherapy amh levels decreased substantially patients 98 05 gl followed significant increase consolidation treatment followup 2 years 68 patients reached baseline amh value overall median recovery 129 iqr 750 2089 compared baseline measurement five patients 7 amh 05 gl patients treated advanced stage disease amh levels remained significantly lower compared early intermediate stage disease median serum amh 13 gl iqr 08 21 2 years patients received decopdac21 consolidation lower amh levels treatment patients receiving copdac28 difference longer statistically significant 2 years postdiagnosis 35 postmenarchal girls receive hormonal cotreatment 19 54 experienced treatmentinduced amenorrhea two girls persisting amenorrhea 2 years studied population comprises young girls diagnosis chl often concurring pubertal transition amh levels naturally rise control population interpretation amh biomarker childhood complex state chl disease may affect amh levels diagnosis potentially complicating assessment amh recovery comparison baseline amh current analysis included data 25 years postdiagnosis current pancare guideline advises use cyclophosphamideequivalent dose score cedscore estimation cumulative alkylating agent exposure cutoff 6000 mgm2 identify females aged 25 years high risk infertility treatmentarms euronetphlc2 protocol remain cutoff based guideline girls treated chl therefore considered lowrisk infertility however although observed increase amh chemotherapy noted girls recovered pretreatment amh levels particularly treated advanced stages chl remains unclear measurements relate agespecific expected amh levels patterns additional longterm data needed explore clinical reproductive outcomes survivors treated according euronetphlc2 protocol fertility addon study funded dutch charity foundation kika project 257 funds research forms childhood cancer cmk dk whw dh mc au ab involved development euronetphlc2 regimen authors indicated potential conflicts interest na