Background: Hodgkin Lymphoma (HL) is a curable lymphoid malignancy affecting a young population of child-bearing age. Many young women are cured and face long-term complications. Among them, infertility holds an important place and the preservation of fertility has become a growing issue. First-line chemotherapy with ABVD (Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine) appears to have low gonadotoxicity, but this toxicity has been rarely studied.

Objective: To provide a new assessment of female fertility by measuring the number of pregnancies and births after ABVD in young women treated for HL compared to an unexposed population.

Patients and Methods: Patients 18 to 40 years of age with HL treated in Angers, Nantes and Poitiers in the trials POF81, MH90 and MH97 conducted from 1981 to 2005 were contacted. The main treatment was ABVD. Two healthy controls were assigned to each patient and matched on age, tobacco consumption and body mass index. Fertility was assessed by the number of pregnancies after HL treatment and the number of births. Data were collected by paper questionnaires.

Results: Sixty-seven patients were included. The median age at diagnosis was 24.4 years (15.6-43.1). Forty-six patients received "standard" intensity treatment: 37 patients were treated with ABVD and 9 patients with EBVM (epirubicin, bleomycin, vinblastine and methotrexate). Twenty-one patients received "enhanced" intensity treatment, 8 of them with autologous stem cells transplantation. All but one received radiotherapy. Fifty-four percent of ABVD-treated patients achieved pregnancy and 82.3% of patients who desired children had at least one birth. In the group of patients, 36 (53.7%) started at least one pregnancy after treatment versus 73 controls (54.5%) (p = 0.92). The median time to pregnancy did not differ between groups [4.8 years (3.1-6.6) in the patients vs. 6.8 years (5-8.7) in the controls, p = 0.214]. Similarly, there was no difference in the use of medically assisted procreation [7 (10.4%) patients vs 7 (5.2%) controls, p = 0.125]. The age at onset of menopause was 44.4 years (36-55) in patients vs 51.5 years (36.2-59) in controls (p = 0.006) without impact on the number of pregnancies. Thirty-six patients (53.7%) wanted to have children after HL treatment: 30 (83.3%) had at least one pregnancy and all but one had at least one birth (80.5% %). There were few premature births in patients (4%) and few neonatal complications [1 failure to thrive (2%)].

Conclusion: In our study, the number of pregnancies and births in young women treated with ABVD for HL is similar to that of the general population, reflecting the low gonadotoxicity of ABVD.

Disclosures

Leleu: Merck: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Pierre Fabre: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

Topics:
bleomycin, dacarbazine, doxorubicin, fertility, hodgkin's disease, vinblastine, bleomycin/dacarbazine/doxorubicin/vinblastine protocol, chemotherapy regimen, epirubicin, failure to thrive

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2017 by The American Society of Hematology
2017
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