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Table 2 Use of GnRH agonists in patients with hematological malignancies

From: The use of GnRH analogs in preserving ovarian function during chemotherapy

References

Objectives

Main findings

Limitations

Salama et al. [29]

Preserving fertility in female patients with hematological malignancies

Given that they have stated that the use of GnRH agonists is debatable, it is worth noting that they have stated that it is not suitable for use in prepubertal females due to inactive HPO axis, does not require a delay in cancer treatment, should be carried out before and during chemotherapy, and that it does not protect against the gonadotoxic effects of radiotherapy.

Systematic review not focusing on the use of GnRH agonists alone

Falorio et al. [30]

Effect of use of GnRH agonists in patients with hematological malignancies on preserving fertility

Out of 61 women, 50 recovered regular menses, and after the completion of treatment, 13 patients conceived successfully.

Small sample size

Driul et al. [31]

Assessment of ovarian function in those taking GnRH agonists against those who do not

The results showed that in those treated with GnRHa, 33% had post-treatment amenorrhea and 6% post-treatment pregnancies, compared to 49% and 4%, respectively, in the control group; however, they have concluded that there was no statistical significance to emphasize on the use of GnRHa and that more evidence should be obtained.

Not done in a recent date

Blumenfeld et al. [32]

Effect of GnRH agonists on spontaneous pregnancies and ovarian function

87% (127 of 146) of the patients in the GnRHa group retained COF and 13% (19 of 146) suffered POF, whereas in the control group, 49% (35 of 71) experienced COF and 51% (36 of 71) suffered POF (P = .0001). The odds ratio (OR) for preserving COF was 6.87 for the patients who received GnRHa (95% confidence interval [CI] 3.4–13.4). Overall, 60% (112 of 188) of the survivors conceived: 69.3% (84 of 122) of the patients in the GnRHa group compared with 42.4% (28 of 66) in the control group (P = .006). In the GnRHa group, 123 healthy newborns were delivered, vs 40 in the controls. Spontaneous pregnancies occurred in 65.6% (80 of 122) of the survivors in the GnRHa group vs 37.9% (25 of 66) in the control group (P = .0004, OR 3.12, 95% CI 1.7–5.8).

Retrospective nature

Blumenfeld et al. [33]

Effect of cotreatment with GnRHa on ovarian damage

The results showed that in the GnRHa/chemotherapy group, 63 out of 65 patients resumed ovulation and regular menses (96.9 %), compared with 63% of the 46 control subjects. Twenty of the 22 patients in the BEACOPP/escalated BEACOPP/GnRHa cotreatment resumed cyclic ovarian function vs 9 of the 14 in the chemotherapy-only group. All 17 MOPP/ABV/GnRHa-cotreated patients resumed COF vs 11 of the 22 in the chemotherapy-only group. Eventually, they concluded that there was no significant effect of the GnRHa cotreatment regarding COF in the ABVD group

Non-Randomized trial

Blumenfeld et al. [34]

Assessment of the rate of POF after stem cell transplantation in women receiving GnRHa in conjunction with gonadotoxic chemotherapy

In 83 patients, 18 out of the 47 patients receiving GnRHa resumed cyclic ovarian function, compared with 4 out of the 36 not receiving GnRHa.

Small sample size

Demeestere et al. [35]

Effect of GnRH agonist administration and ovarian function preservation

37 patients who had AMH levels available at least once during the follow-up period, the mean AMH values decreased significantly after treatment (3.14 ± 0.80 ng/mL at inclusion vs 1.26 ± 0.3 ng/mL after 2 to 4 years, P = .039) and remained at a similar level after 5 to 7 years (1.58 ± 0.38 ng/mL, P = .520). A higher rate of low AMH (AMH < 0.5 ng/mL) was observed in both groups after 2 to 4 years of follow-up.

Small sample size