Chemotherapy-induced leucopenia linked to amenorrhea in young women
MedWire News: A lower leukocyte count after treatment with fluorouracil, epirubicin, and cyclophosphamide (FEC) is associated with an increased risk for amenorrhea in young, premenopausal women with breast cancer, study findings indicate.
The researchers also confirmed that the risk for amenorrhea after FEC-treatment was strongly associated with the age of the patient and the dose of chemotherapy.
In their study of 1016 premenopausal women with breast cancer, Mikkel Rosendahl (Copenhagen University Hospital, Rigshospitalet, Denmark) and colleagues examined the association between chemotherapy-induced leucopenia and the development of amenorrhea.
The women received seven series of FEC. In the first series, all patients were given a standard dose. Then, patients whose leukocytes dropped to between 1.0 and 1.9×109/l continued with the standard dose for the remaining six series, while patients whose lowest leukocyte count was 2×109/l or above were randomly assigned to receive the standard regimen or an increased dose of epirubicin and cyclophosphamide. Absent bleeding after the fifth to seventh series of FEC was interpreted as amenorrhea.
The researchers report that, overall, significantly more women in the youngest age group (25–39 years) maintained bleeding compared with the oldest age group (50–57 years) at 67.9% versus 1.8%. Furthermore, amenorrhea was significantly more common among patients randomly assigned to receive the increased dose of chemotherapy compared with those given the standard dose (80.6% vs 71.7%).
In an age-stratified analysis of the standard treatment groups, Rosendahl et al found that low leukocyte count after initial treatment was significantly associated with amenorrhea for patients aged 25 to 39 years.
Age-stratified analysis of the randomized groups revealed that the risk for amenorrhea was 2.9- and 1.2-fold higher among women aged 25 to 39 years and 40 to 44 years, respectively, who received the higher chemotherapy dose, compared with those who received the standard dose. There was no dose-related increased risk for amenorrhea among women aged 45 to 57 years.
Writing in the European Journal of Cancer, Rosendahl and co-authors suggest that the older patients, who already have fewer oocytes, become amenorrheic more easily in response to standard doses of FEC chemotherapy.
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By Laura Dean