Fertility in female survivors of Hodgkin's lymphoma

Abstract

Currently, Hodgkin's lymphoma is one of the most curable types of cancer. Patients are often young and so the long-term morbidities of treatment have become of increasing concern. Among these, infertility is one of the most challenging consequences for patients in reproductive age. Premature ovarian failure in premenopausal women is a serious long-term sequel of the toxicity of chemotherapy. The main consequence of this syndrome is infertility, but women also present other symptoms related to estrogen deprivation. Different rates of impaired gonadal function are reported, depending on the patient's age, stage of disease, dose and intensity of chemotherapy and the use of radiation therapy. The most established strategy in female infertility is cryopreservation of embryos after in vitro fertilization. Additionally, the use of oral contraceptives or gonadotropinreleasing hormone analogs (GnRH-a) during treatment is under study. This review will provide a general overview of the main studies conducted to evaluate the infertility rate among female Hodgkin's lymphoma survivors and risk factors associated to treatment, different end-point definitions for evaluating fertility and also a brief description of the available strategies for fertility preservation.

Fertility in young patients following treatment for Hodgkin’s lymphoma: a single center survey

“…There have been many studies dealing with fertility in patients following HL treatment performed to the present day [ 2 , 4 – 6 , 10 – 12 ]. The dose-escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone, where the alkylating agents are cyclophosphamide and procarbazine) regimen has been linked to a higher incidence of secondary amenorrhea than the ABVD regimen (doxorubicin, vinblastine, dacarbazine, and bleomycin, where an alkylating agent is dacarbazine); these two being the most frequently used regimens [ 3 , 4 , 13 ].…”

Contemporary representations about the treatment of Hodgkin’s lymphoma in children and adolescents. Review

“…Кумулятивная доза прокарбазина напрямую влияет на снижение фертильности у мальчиков [20,21]. У женщин применение прокарбазина повышает риск развития преждевременной недостаточно-сти яичников на 11 % на каждые 1,4 г/м 2 кумулятивной дозы [22]. Исследовательская группа DAL в исследовании DAL-HD90 показала, что прокарбазин может быть заменен на этопозид в индукционных блоках у мальчиков без потери эффективности.…”

Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents

“…The risk of premature ovarian failure (POF) after exposure to cyclophosphamide is 50%, however this is seen at a mean cumulative dose of 9·3 g, which is substantially higher than that used in low‐risk HL protocols (2·4–3·6 g/m 2 ). Exposure to procarbazine increases the incidence of POF in females by 11% for each 1·4 g/m 2 (Biasoli et al , ) and is associated with high risk of azoospermia in males (Levine et al , ). Lastly, the risk of anthracycline‐induced cardiac toxicity is higher in children.…”