Management of fertility in patients treated for Hodgkin's lymphoma

Harel, Stéphanie; Fermé, Christophe; Poirot, Catherine

doi:10.3324/haematol.2011.045856

Cited by 83 publications

(56 citation statements)

References 52 publications

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“…with a high incidence of ovarian toxicity, while regimens such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) are associated with less risk [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

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Purpose Chemotherapeutic agents have a known gonadotoxic effect; however, it is difficult to predict the impact they may have on ovarian stimulation. The objective of this study was to evaluate response to ovarian stimulation in patients exposed to chemotherapy compared with patients who were chemotherapy-naïve. Methods A retrospective cohort study of 130 patients with cancer or autoimmune disease was performed. Demographics, ovarian reserve, ovarian response and stimulation parameters, and oocyte data were compared between patients who were pre-and post-chemotherapy. Logistic regression modeling was performed to identify risk factors for cancellation and low oocyte yield, adjusting for confounders as appropriate. Results Antral follicle count (AFC) was significantly lower in post-chemo patients (9 vs. 17, p<0.001). Post-chemotherapy patients were more likely to be cancelled during stimulation (23 vs. 4 %, p=0.003). Among those that went to retrieval, there was no difference in total number of oocytes (10 vs. 10, p=0.31) or mature oocytes retrieved (8 vs. 8, p=0.38), despite higher starting (300 vs. 450 IU, p<0.001) and total gonadotropin (3075 vs. 4612.5 IU, p=0.008) doses in post-chemotherapy patients. Low AFC (≤6) was associated with cycle cancellation (OR 7.7, 95 % CI 1.8-33.2) and low oocyte yield (<6) (OR 5.4, 95 % CI 1.6-17.7). Conclusions Patients post-chemotherapy have lower AFC compared with the chemotherapy-naïve and have higher cancellation rates. Among those who underwent oocyte retrieval, oocyte yield was similar in both groups. Low AFC was most strongly associated with cycle cancellation and oocyte yield. Post-chemotherapy patients had higher rates of cycle cancellation but did equally well as pre-chemotherapy patients if they reached retrieval.

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“…with a high incidence of ovarian toxicity, while regimens such as doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) are associated with less risk [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ovarian stimulation after treatment with chemotherapy

Chan

Johnson

Efymow

et al. 2015

J Assist Reprod Genet

View full text Add to dashboard Cite

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“…These lesions induce apoptosis that not only affects the follicle but also the growing population of primordial follicles 6 . The risk of developing POF is correlated with age, the status of the ovarian reserve before treatment initiation, the type of chemotherapy and the cumulative dosage 6 Established methods include cryopreservation of embryos and/or ova, and ovarian transposition. Others such as ovarian tissue preservation are new, yet promising, fertility preservation treatments, with the first live birth after autotransplantation of human ovarian tissue reported in 2004.…”

mentioning

confidence: 99%

Controversies over the use of GnRH agonists for reduction of chemotherapy-induced gonadotoxicity

Garrido-Oyarzún

Castelo-Branco

2016

Climacteric

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“…The number of achieved pregnancies was directly related to the number of ovarian follicles that were not damaged by cancer treatment. There is very little relevant information regarding pregnancy occurrence after HL treatment [5,20]. There were two pregnancies reported in a Giuseppe randomized trial in the group of patients not receiving GnRH-a during their HL treatment [16].…”

Section: Discussionmentioning

confidence: 99%

Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues

Hüser

Šmardová

Janků

et al. 2015

J Assist Reprod Genet

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Purpose Aim of this prospective observational study was to analyze fertility status of Hodgkin lymphoma (HL) patients treated with different types of chemotherapy while receiving GnRH analogues to preserve ovarian function. Methods Fertility status was assessed among 108 females in reproductive age treated by curative chemotherapy for freshly diagnosed HL between 2005 and 2010 in university-based tertiary fertility and oncology center. All patients received GnRH analogues during chemotherapy to preserve their ovarian function. Their reproductive functions were assessed by follicle-stimulating hormone (FSH) measurement and pregnancy achievement. Ovarian function was determined separately in three groups with increasing gonadotoxicity of chemotherapy.Results One year following the treatment, normal ovarian function was found in 89 (82.4 %) of patients. Two years after chemotherapy, 98 (90.7 %) of patients retained their ovarian function, and 23 (21.3 %) achieved clinical pregnancy during the follow-up period. Average FSH after chemotherapy was 11.6±17.9 IU/l 1 year after the treatment resp. 9.0±13.8 at the 2 years interval. There were significantly more patients with chemotherapy induced diminished ovarian reserve (chDOR) among the group receiving escalated BEACOPP chemotherapy in comparison with the other types of treatment (58.1 % vs. 87.9 % resp. 95.5 %). Conclusion The rate of chDOR is significantly higher after EB poly-chemotherapy and there is no tendency for improvement in time. The 2+2 chemotherapy with GnRH-a required for more advanced HL retained ovarian function significantly better after 2 years. Another important advantage of GnRH-a co-treatment is the excellent control of patient's menstrual cycle.

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Management of fertility in patients treated for Hodgkin's lymphoma

Cited by 83 publications

References 52 publications

Outcomes of ovarian stimulation after treatment with chemotherapy

Outcomes of ovarian stimulation after treatment with chemotherapy

Controversies over the use of GnRH agonists for reduction of chemotherapy-induced gonadotoxicity

Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues

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