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Infertility as a consequence of therapy presents a high psychosocial burden for HL patients. In the cohort of our analyzed patients, within the post-ABVD surviving patients, alterations of the spermogram were documented in a total of 6.1% of the male patients and 5.4% of the female patients developed amenorrhea. On the other hand, within the subgroup of surviving patients following BEACOPP chemotherapy, 60% of the male patients manifested defects in their spermogram, and as high as 28.6% of the female survivors reported loss of their monthly cycle. It has been reported on several occasions that even prior to treatment, the sperm of HL patients manifests poorer quality characteristics when analyzed against control specimens from healthy male donors. The analyzed results in ABVD-treated male HL patients confirm ABVD to be a safe regimen for males of all age categories, as well as for female patients under the age of thirty. In women above the age of 30, the infertility risk rate is relatively low (14%), which leaves the decision of preserving fertility to themselves. For all BEACOPP-treated female, as well as male patients, a consult with a reproductive medicine specialist is warranted prior to therapy, due to the high infertility risk, and the final decision should be made on an individual basis.

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Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage “0” according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still with-out treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies.

Background:Results from many analyses and trials have shown that combined modality treatment contributes to better vital statistics for HD patients, compared to chemotherapy‐only treatment. In previous analyses, we have also argumented this point, validating it on our patient population. However, our previous analyses were performed mainly on HD patients initially treated with COPP‐like regimens.Aims:To analyze whether HD patients initially treated at our Clinic with the ABVD (and derived) regimen(s) still benefit from the addition of radiotherapy as a treatment component.Methods:Within the past two decades we used ABVD as initial treatment in a total of 272 HD patients. In more than 70% of these, chemotherapy only was the treatment mode administered. Almost 30% of these patients required addition of radiotherapy, as part of a recommended combined modality treatment option, or, in a minority of cases, as adjuvant treatment to sites of residual or bulky tumor mass.Results:ABVD as induction treatment achieves 5yOS in 91% of patients, and 10yOS for 85% of the patients. The survival curve maintains a plateau at 82.5% after the 150‐month mark. The 77 patients treated with the combined modality treatment/adjuvant chemotherapy maintain a 4% margin of superiority in the OS, across the first 10 years of follow‐up. Nevertheless, both survival curves almost merge after the 15th year, and maintain a continuous plateau thereafter. The benefit is more evident when PFS is analyzed. All clinical stages maintain a continuous difference between the plateaus of the curves, starting from the third year of follow‐up, varying from 2‐6% among different CS categories. Although a small category (8 patients), even the advanced stage patients treated with adjuvant radiotherapy benefit from this option, maintaining a 100% OS and PFS line. It should be clearly stated that in our analysis the differences do not reach a statistically significant level in terms of p‐values, probably due to the relatively small number of patients analyzed, the notable disproportion among the patients with completed vs. censored observations, as well as because of the numeric misbalance among the groups treated with the two treatment options.Summary/Conclusion:Having balanced all observations, we still recommend that radiotherapy is not omitted as a very beneficial mode of treatment across all stages of the disease (abiding firmly by the indications for evidence‐based utilization of this option), contributing to a (maybe) marginal, but still a continuous advantage in the vital statistics of HD patients. Not neglecting the everlasting concerns of the community with regard to the adverse late effects of radiotherapy, hopes should turn towards dose modifications and field adjustments, as well as technological improvements of radiotherapy, rather than abandoning this treatment modality.