Ovarian protection with gonadotropin-releasing hormone agonists during cyclophosphamide therapy in systemic lupus erythematosus. 2020

Ruba Kado, and W Joseph McCune
Division of Rheumatology Department of Internal Medicine, University of Michigan, Suite 7C27 North Ingalls Building, 300 North Ingalls SPC 5422, Ann Arbor, MI, 48109-5422, USA; Michael and Marcia Klein, Professor of Rheumatic Diseases, Division of Rheumatology, Director Lupus Program, Department of Internal Medicine, University of Michigan, Suite 7C27 North Ingalls Building, 300 North Ingalls, Ann Arbor, MI, 48109, USA. Electronic address: kador@med.umich.edu.

Administration of cyclophosphamide (CYC), an alkylating agent used to treat malignancies and severe rheumatic diseases, creates a risk of ovarian insufficiency that is related to the intensity and duration of therapy and the age of the patient. To preserve reproductive capacity in the appropriate clinical setting, oocyte, embryo, and/or ovarian tissue cryopreservation are recommended. Medical protection with depot gonadotropin-releasing hormone agonists (GNRHa) has emerged as a potential means to preserve both fertility and ovarian function through the suppression of ovarian activity during treatment with alkylators. We review the trials of GNRHa for ovarian protection in both cancer and rheumatic disease patients. Trials in cancer patients receiving CYC alone, or in combination with other gonadotoxic agents that have employed several different GNRHa have yielded mixed results. Trials in lupus patients receiving lower doses of CYC alone utilizing depot leuprolide acetate have tended to show favorable results.

UI MeSH Term Description Entries
D007166 Immunosuppressive Agents Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. Immunosuppressant,Immunosuppressive Agent,Immunosuppressants,Agent, Immunosuppressive,Agents, Immunosuppressive
D007987 Gonadotropin-Releasing Hormone A decapeptide that stimulates the synthesis and secretion of both pituitary gonadotropins, LUTEINIZING HORMONE and FOLLICLE STIMULATING HORMONE. GnRH is produced by neurons in the septum PREOPTIC AREA of the HYPOTHALAMUS and released into the pituitary portal blood, leading to stimulation of GONADOTROPHS in the ANTERIOR PITUITARY GLAND. FSH-Releasing Hormone,GnRH,Gonadoliberin,Gonadorelin,LH-FSH Releasing Hormone,LHRH,Luliberin,Luteinizing Hormone-Releasing Hormone,Cystorelin,Dirigestran,Factrel,Gn-RH,Gonadorelin Acetate,Gonadorelin Hydrochloride,Kryptocur,LFRH,LH-RH,LH-Releasing Hormone,LHFSH Releasing Hormone,LHFSHRH,FSH Releasing Hormone,Gonadotropin Releasing Hormone,LH FSH Releasing Hormone,LH Releasing Hormone,Luteinizing Hormone Releasing Hormone,Releasing Hormone, LHFSH
D008180 Lupus Erythematosus, Systemic A chronic, relapsing, inflammatory, and often febrile multisystemic disorder of connective tissue, characterized principally by involvement of the skin, joints, kidneys, and serosal membranes. It is of unknown etiology, but is thought to represent a failure of the regulatory mechanisms of the autoimmune system. The disease is marked by a wide range of system dysfunctions, an elevated erythrocyte sedimentation rate, and the formation of LE cells in the blood or bone marrow. Libman-Sacks Disease,Lupus Erythematosus Disseminatus,Systemic Lupus Erythematosus,Disease, Libman-Sacks,Libman Sacks Disease
D003520 Cyclophosphamide Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the LIVER to form the active aldophosphamide. It has been used in the treatment of LYMPHOMA and LEUKEMIA. Its side effect, ALOPECIA, has been used for defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. (+,-)-2-(bis(2-Chloroethyl)amino)tetrahydro-2H-1,3,2-oxazaphosphorine 2-Oxide Monohydrate,B-518,Cyclophosphamide Anhydrous,Cyclophosphamide Monohydrate,Cyclophosphamide, (R)-Isomer,Cyclophosphamide, (S)-Isomer,Cyclophosphane,Cytophosphan,Cytophosphane,Cytoxan,Endoxan,NSC-26271,Neosar,Procytox,Sendoxan,B 518,B518,NSC 26271,NSC26271
D005260 Female Females
D005300 Fertility Agents, Female Compounds which increase the capacity to conceive in females. Fertility Agents, Female, Hormonal,Fertility Agents, Female, Synthetic,Infertility Agents, Female,Female Fertility Agents, Synthetic,Infertility Drugs, Female,Synthetic Female Fertility Agents,Agents, Female Fertility,Agents, Female Infertility,Drugs, Female Infertility,Female Fertility Agents,Female Infertility Agents,Female Infertility Drugs
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000477 Alkylating Agents Highly reactive chemicals that introduce alkyl radicals into biologically active molecules and thereby prevent their proper functioning. Many are used as antineoplastic agents, but most are very toxic, with carcinogenic, mutagenic, teratogenic, and immunosuppressant actions. They have also been used as components in poison gases. Alkylating Agent,Alkylator,Alkylators,Agent, Alkylating,Agents, Alkylating
D016649 Primary Ovarian Insufficiency Cessation of ovarian function after MENARCHE but before the age of 40, without or with OVARIAN FOLLICLE depletion. It is characterized by the presence of OLIGOMENORRHEA or AMENORRHEA, elevated GONADOTROPINS, and low ESTRADIOL levels. It is a state of female HYPERGONADOTROPIC HYPOGONADISM. Etiologies include genetic defects, autoimmune processes, chemotherapy, radiation, and infections. The most commonly known genetic cause is the expansion of a CGG repeat to 55 to 199 copies in the 5' untranslated region in the X-linked FMR1 gene. Gonadotropin-Resistant Ovary Syndrome,Ovarian Failure, Premature,Resistant Ovary Syndrome,FMR1-Related Primary Ovarian Insufficiency,Fragile X Premature Ovarian Failure,Fragile X-Associated Primary Ovarian Insufficiency,Hypergonadotropic Ovarian Failure, X-Linked,Premature Ovarian Failure,Premature Ovarian Failure 1,Premature Ovarian Failure, X-Linked,Primary Ovarian Insufficiency, Fragile X-Associated,X-Linked Hypergonadotropic Ovarian Failure,FMR1 Related Primary Ovarian Insufficiency,Fragile X Associated Primary Ovarian Insufficiency,Gonadotropin Resistant Ovary Syndrome,Hypergonadotropic Ovarian Failure, X Linked,Ovarian Insufficiency, Primary,Premature Ovarian Failure, X Linked,Primary Ovarian Insufficiency, Fragile X Associated,X Linked Hypergonadotropic Ovarian Failure
D016729 Leuprolide A potent synthetic long-acting agonist of GONADOTROPIN-RELEASING HORMONE that regulates the synthesis and release of pituitary gonadotropins, LUTEINIZING HORMONE and FOLLICLE STIMULATING HORMONE. Leuprorelin,A-43818,Enantone,Leuprolide Acetate,Leuprolide Monoacetate,Leuprolide, (DL-Leu)-Isomer,Leuprolide, (L-Leu)-Isomer,Lupron,TAP-144,A 43818,A43818,Acetate, Leuprolide,Monoacetate, Leuprolide,TAP 144,TAP144

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