Reproduction following treatment for childhood leukemia: A population‐based prospective cohort study of fertility and offspring

Abstract

Of all children diagnosed with leukemia in Denmark, Finland, Iceland, Norway, and Sweden, 981 had discontinued therapy before 1985 and had been followed up annually after cessation of therapy. Progeny was registered and fertility evaluated among survivors who passed age 18 years without a relapse (n = 299). By April 1989, 48 offspring were registered, one of whom had congenital anomalies. This was no more than expected from the incidence of birth defects in the general population. No childhood malignancies or genetic diseases have so far been diagnosed in the progeny. In the study group, none of the 19 female and 8 male survivors of myeloid leukemias had become parents, and only 4 fathers were reported among the 131 male survivors of acute lymphoblastic leukemia (ALL). However, 23 of the 149 females treated for ALL had delivered 41 children. Fertility was measured as cumulative rates of first birth by maternal age. In a Cox regression analysis, cases who had received prophylactic radiation of the central nervous system (CNS) had a lower first birth rate than those without radiation (rate ratio 0.39, 95% CI 0.15-1.00), indicating that doses of 18-24 Gy to the brain may possibly be a risk factor. By using the Norwegian birth cohort of 1966 as a control group, matching the median year of birth for the study subjects, the group of female ALL survivors as a whole was as likely as the general female population to have given birth up to the age of 23. The first generation of females successfully treated for childhood ALL seems to have a nearly normal reproductive pattern during young adulthood, without increased risk of congenital anomalies in the offspring. However, cranial radiation as CNS prophylaxis may possibly impair subsequent reproduction.

Social outcomes in young adult survivors of low incidence childhood cancers

“…Thus, differences across diagnoses may become more apparent with increasing age. The findings in this report are in concordance with many studies [5,[55][56][57][58] even though others have not shown any difference between survivors and controls [7,12,36].…”

Military service of male survivors of childhood malignancies

“…For statistical analyses some variables were grouped as follows: diagnoses: 1) leukemias (n ϭ 81), b) lymphomas (n ϭ 47), c) tumors of the central nervous system (CNS) (n ϭ 24) and d) other malignant solid tumors (n ϭ 55); surgery groups: a) no surgery or biopsy only (n ϭ 106), b) mutilating or extractive surgery (n ϭ 57) (amputation [8], osteotomy [3], brain surgery [22], splenectomy [9], and nephrectomy [15]), and c) others (n ϭ 44); other sequelae: a) no other sequelae (n ϭ 156), b) limb deformities (n ϭ 18) (amputation [8], caput necrosis of femur [2], growth delay of a limb [6], and paresis of a limb [2]) and c) other single sequelae (n ϭ 33) (impairment of vision [3], hearing [1], or balance [2]; epilepsy [3]; developmental impairment [4]; problems with heart [2], lung [2], bowel [2], or bladder [1]; functionally harmful cicatrices [3]; alopecia [1], secondary malignancies [2], thrombocytopenia [1], and delayed puberty [6]). …”

Impact of Cancer Therapy on the Reproductive Axis

“…In two register-based studies of 299 and 409 young adults treated for ALL, a normal fertility rate and no excess of malformations were found [27, 28]. No evidence of increased risk of cancer in the offspring has been documented [29].…”