The Effect Of Cyclophosphamide Pulse Therapy On Sexual Development In Puberty Males

Objective: To evaluate the cumulative effect of cyclophosphamide (CTX) pulse therapy on sexual development in early and middle period puberty males according to the index of serum inhibin B(INH-B) and the correlation between INH-B and follicle stimulating hormone(FSH), luteinizing hormone(LH) and total testosterone(TT).Methods: Examined 200 normal early and middle period puberty boys'serum INH-B concentration to determine its reference range. The secondary sexual characteristics about 31 early and middle period puberty males who accepted cyclophosphamide pulse therapy were observed and serum INH-B, FSH, LH, TT were examined. The tendency of each index in different cumulative dose was analysed.Results: (1)16 of 31 patients'secondary sexual characteristics were observed repeatedly and there was no difference between different CTX cumulative dose. (2)Serum FSH levels of 9-11.9years old and 12-15years old and serum LH level of 9-11.9 years old were increased with the CTX cumulative dose and they were significant when cumulative dose>100mg/kg. But serum LH level of 12-15years old and serum TT level of 9-11.9 years old and 12-15 years old have no signification difference in groups. (3)There was no statistically significant of INH-B levels in 7 groups from 9 to 15years old(P=0.882) and its concentration was (339.61±121.69)pg/ml. INH-B level was decreased along with the CTX cumulative dose increasing. It was significant when CTX cumulative dose>60mg/kg. (4)Signification negative relationship was observed between INH-B and FSH(r=-0.381, P=0.03) and no correlation with LH and TT. (5) Serum INH-B/FSH was decreased along with the CTX cumulative concentration increasing, too. It was significant when CTX cumulative dose >100mg/kg in age stage from 9 to 11.9 years old, while 12 to 15years old was >60mg/kg. (6) There were 2 patients who rest more than half a year from last therapy. Their serum FSH, LH, TT and INH-B levels were all normal except one child's FSH (13.1mIU/ml).Conclusion: (1) Serum INH-B level of 9-15 years old was (339.61±121.69) pg/ml. Regular increase of serum INH-B during puberty was not found. (2) Cumulative effect of CTX pulse therapy to sexual development existed in short term and it was more sensitive in elder age group, while whether there is long term damages needs further studies. (3) Signification negative relationship was observed between INH-B and FSH and no correlation with LH and TT. Serum INH-B as a marker of steroli cell function is superior to FSH, LH, TT and INH-B/FSH. The decrease of its level is significant when CTX cumulative dose>60mg/kg. (4) Chose other immunosuppressive agents as a sequential therapy to reduce gonad damage if diseases were controlled after 3 times cyclophosphamide pulse therapy.