Male and Female Fertility: Prevention and Monitoring Hodgkin’ Lymphoma and Diffuse Large B-Cell Lymphoma Adult Survivors. A Systematic Review by the Fondazione Italiana Linfomi

Viviani, Simonetta; Caccavari, Valentina; Gerardi, Chiara; Ramadan, Safaa; Allocati, Eleonora; Minoia, Carla; Guarini, Attilio; Russo, Anna

doi:10.3390/cancers13122881

Cited by 18 publications

(18 citation statements)

References 62 publications

(124 reference statements)

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“…Diffuse large B-cell lymphoma is the most frequent type among invasive lymphoma, representing 30.0-40.0% of all non-Hodgkin's lymphoma (NHL) (1,2). It is regarded as a heterogeneous lymphoma in clinical features, tumor biology, and prognosis (3,4).…”

Section: Introductionmentioning

confidence: 99%

Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin’s Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation

Wang

et al. 2021

Front. Oncol.

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BackgroundAmong the growing number of patients with hematologic neoplasms hospitalized in the intensive care unit (ICU), the largest proportion of these patients are diagnosed with lymphoma. However, less attention has been paid in the past to identifying critically ill patients and assessing the prognosis of patients in ICU. Traditional critical care-related scores have shown limitations and inaccuracy in predicting mortality risk.MethodsPatients diagnosed with diffuse large B-cell lymphoma (DLBCL) were searched for in the Marketplace for Information in Intensive Care Medicine III (MIMIC-III) database. We searched mortality within 28 days as the primary endpoint. Logistics regression was used to screen risk factors. A calibration curve was used for internal validation, and the ROC curve and AUC were used to compare the new model with traditional scores.Results405 patients with DLBCL are enrolled in the project. Multivariate analysis shows the patients with the level of lactate dehydrogenase (LDH) > 327 U/L had an increased risk of 28-day mortality in ICU than others (OR = 13.04, p<0.01). Notably, length of ICU stay, LDH, creatinine, white blood cell counts, and APS III score are independent prognostic factors for patients with DLBCL in the ICU. Then, all these independent prognostic factors are selected into our prediction model. The new model has good accuracy (C-index=0.863) and a calibration curve, which improves clinical status concerning established ratings such as IPI, NCCN-IPI score, SOFA, APS III, and LODS. The results of a multicenter external validation including 124 DLBCL patients also showed that the new model was more accurate than all other models.ConclusionsThe elevated level of LDH indicates a poor prognosis of patients with DLBCL in the ICU. Our risk score with crossed validation based on the level of LDH shows a significant prognostic value and may be a valuable tool for assessing the critically ill as well.

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Section: Introductionmentioning

confidence: 99%

Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin’s Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation

Wang

et al. 2021

Front. Oncol.

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“…The EB protocol, comprising two gonadotoxic alkylating agents, cyclophosphamide and procarbazine, is applied in the management of HL and is associated with higher PFS than ABVD. However, this often comes at the expense of increased treatment-related gonadotoxicity [47,48] that is an established contributing factor to reduced BMD. As early as 4 decades ago, Waxman et al revealed long-term gonadotoxicity of the MOPP (nitrogen mustard, vinblastine, prednisolone, procarbazine) regimen in patients with advanced-stage HL [31].…”

Section: Discussionmentioning

confidence: 99%

Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received

Ofshenko¹,

Bercovich

Mashiach

et al. 2022

Cancers

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Nowadays, Hodgkin lymphoma (HL) has become highly curable. The young age at diagnosis and long life expectancy emphasize the importance of preventing long-term treatment side effects, including bone mineral density (BMD) loss, in these patients. We aimed to evaluate the effects of first-line therapeutic modalities on BMD dynamics in HL patients, intending to identify individuals at risk for osteopenia. Demographics, HL risk factors, treatment, including cumulative steroid doses, and BMD of 213 newly-diagnosed HL patients (median age 29 years), treated at Rambam between 2008–2016, were analyzed. The main chemotherapy regimens applied were: ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (EB; bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine, prednisone). BMD was measured using PET/CT scans. BMD loss >15% was revealed in 48% of patients at therapy completion, with osteopenia prevalence of 4% and 14% at baseline and post-therapy, respectively. Cumulative hydrocortisone equivalent doses >3400 mg/m2 correlated with significant BMD reduction. Multivariate analysis at 6 months post-therapy identified age ≥30 years and EB-regimens as significant risk factors for BMD decrease >15%. Therapy-related BMD loss is common in HL patients. Its persistence is associated with age ≥30 years and EB treatment. Reduction of cumulative steroid doses and switch to non-gonadotoxic drugs should be considered.

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“…Infertility and pregnancy loss is a well-recognized phenomenon in other blood disorders affecting B lymphocytes, such as lymphoproliferative diseases (ie, Hodgkin lymphoma and B NHLs). Infertility in these cases, which is due to both the disease (ie, azoospermia in males, reduced ovarian reserve, premature menopause in females) and the anticancer treatment, is reversible in most cases [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Pregnancy and Persistent Polyclonal B Cell Lymphocytosis (PPBL): A Case Study of a Rare Co-Existence

et al. 2021

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Patient: Female, 35-year-old Final Diagnosis: Succesful pregnancy Symptoms: Pain • pregnancy Medication: — Clinical Procedure: — Specialty: Hematology • Obstetrics and Gynecology Objective: Unknown etiology Background: Persistent polyclonal B cell lymphocytosis (PPBL) is a benign clinical condition, which is characterized by persistent absolute polyclonal B lymphocytosis (>4.0 K/μL), with the presence of circulating binucleated lymphocytes on the peripheral blood smear and an extra 3 chromosome long arm i(3q) in most cases. Immunophenotype reveals the polyclonal population of B cell lymphocytes with expression of CD19, CD20, and CD22 antigens, and κ and λ immunoglobulin light chains. Patients are mostly asymptomatic. Although PPBL has a benign clinical course and does not affect the survival expectancy of most patients, pregnancy seems to be extremely rare in these patients, as only 1 case reported so far. Although the real role of immunologic disorders, possibly PPBL, in recurrent pregnancy losses remains unclear, the rarity of successful pregnancy in PPBL patients could be attributed to the possible association of PPBL with infertility or recurrent miscarriages. Case Report: In the present study we present the second published case of a woman with a typical PPBL and recurrent pregnancy loss with a successful pregnancy outcome. Close clinical and laboratory monitoring in combination with the administration of thromboprophylaxis and the induction of mild immunosuppression with low-dose prednisolone may have contributed to the successful outcome of the pregnancy. Conclusions: In conclusion and taking all these findings into consideration, pregnancy in patients with PPBL seems to be extremely rare and the contribution of PPBL to the 2 previous miscarriages in our case could not be excluded.

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Male and Female Fertility: Prevention and Monitoring Hodgkin’ Lymphoma and Diffuse Large B-Cell Lymphoma Adult Survivors. A Systematic Review by the Fondazione Italiana Linfomi

Cited by 18 publications

References 62 publications

Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin’s Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation

Elevated Lactate Dehydrogenase Levels Display a Poor Prognostic Factor for Non-Hodgkin’s Lymphoma in Intensive Care Unit: An Analysis of the MIMIC-III Database Combined With External Validation

Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received

Successful Pregnancy and Persistent Polyclonal B Cell Lymphocytosis (PPBL): A Case Study of a Rare Co-Existence

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