Hodgkin lymphoma and female fertility: a multicenter study in women treated with doxorubicin, bleomycin, vinblastine, and dacarbazine

Abstract

Preservation of fertility has become a growing concern in young females with Hodgkin lymphoma (HL). However, the rate of pregnancy after the current most frequently prescribed ABVD chemotherapy for HL has rarely been studied. We aimed to determine the impact of ABVD on the fertility of women treated for HL. A non-interventional, multicentric study of female patients of child-bearing age with HL treated. Two healthy apparied women non exposed at chemotherapy (our controls) were assigned for each patient. Fertility was assessed by the number of pregnancies and births after HL treatment. Sixty-seven patients were included. The median age at diagnosis was 24.4 years (16-43). Hodgkin lymphoma was localized disease for 68.7%. 53.7% of all the patients started at least one pregnancy after treatment versus 54.5% of the controls (p=0.92). 81% of patients who desired children had at least one pregnancy. Patients treated with ABVD did not have a longer median time to pregnancy (4.8 years in the group of patients and 6.8 years for controls). Across patients, there has been 58 pregnancies and 48 births (ratio 1.2) and for control cohort, 136 pregnancies and 104 births (ratio 1.3). No increase in obstetric or neonatal complications has been reported in HL in our study. The number of pregnancies, births and the time to start a pregnancy in young women treated with ABVD for HL is not different to that of controls. Therefore, female with HL and treated by ABVD should be reassured in regards to fertility.

Fertility preservation and monitoring in adult patients diagnosed with lymphoma: consensus-based practical recommendations by the Fondazione Italiana Linfomi & Società Italiana della Riproduzione Umana

“…Available studies measure the restoration of menses but also the rate of live births ( 44 ). It should be emphasized that, when administered to female patients aged over 35 years, the risk of infertility increased and could reach 20-40% ( 42 , 44 ,– 45 ). In fact, ovarian function reserve measured by recovery of AMH one year after the end of 6 cycles of ABVD/AVD was significantly reduced compared with females younger than 35 years ( 46 ).…”

Successful Pregnancy and Fetal Outcomes Following Brentuximab Vedotin for Early Relapsed Classic Hodgkin Lymphoma After Autologous Stem Cell Transplant

“…In a retrospective cohort study, the number of pregnancies and births in young women treated with ABVD for cHL was similar to that of the general population. Although transient amenorrhea and premature menopause occurred more frequently in patients than in controls, fertility following ABVD was not affected [ 17 ]. However, the effects of BV on human fertility have not been evaluated.…”

Classic Hodgkin Lymphoma in Adolescents and Young Adults

“…However, ABVD therapy does not seem to affect the number of pregnancies, births, and the time to start a pregnancy. 68 Among male survivors, abnormalities in semen analyses, including azoospermia (33%-100%; median, 75%) and oligospermia (0%-33%; median, 17.5%), have been reported. Infertility risks are primarily associated with exposure to higher cumulative doses of alkylating agents, especially procarbazine (with BEACOPP), infradiaphragmatic RT, and after ASCT.…”