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Fertility and gonadal function in female survivors after treatment of early unfavorable Hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial

Behringer, K. ; Thielen, I. ; Mueller, H. ; Goergen, H. ; Eibl, A. D. ; Rosenbrock, J. ; Halbsguth, T. ; Eichenauer, D. A. ; Fuchs, M. ; Reiners, K. S. ; Renno, J. H. ; van der Ven, K. ; Kuehr, M. ; von Wolff, M. ; Diehl, V. ; Engert, A. ; Borchmann, P.

In: Annals of Oncology, 2012, vol. 23, no. 7, p. 1818-1825

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    Title
    • Fertility and gonadal function in female survivors after treatment of early unfavorable Hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial
    Author
    • Behringer, K.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Thielen, I.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Mueller, H.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Goergen, H.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Eibl, A. D.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Rosenbrock, J.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Halbsguth, T.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Eichenauer, D. A.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Fuchs, M.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Reiners, K. S.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Renno, J. H.. Institute for Clinical Chemistry, University of Cologne, Cologne
    • van der Ven, K.. Department of Gynecological Endocrinology and Reproductive Medicine, University of Bonn, Bonn, Germany
    • Kuehr, M.. Department of Gynecological Endocrinology and Reproductive Medicine, University of Bonn, Bonn, Germany
    • von Wolff, M.. Department of Gynecological Endocrinology and Reproductive Medicine, University Women's Hospital, Bern, Switzerland
    • Diehl, V.. German Hodgkin Study Group, First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Engert, A.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    • Borchmann, P.. First Department of Internal Medicine, University Hospital of Cologne, Cologne
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Annals of Oncology, 2012, vol. 23, no. 7, p. 1818-1825. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:294786
    Summary
    Background In the HD14 trial, 2× BEACOPPescalated+2× ABVD (2+2) has improved the primary outcome. Compared with 4× ABVD, this benefit might be compromised by more infertility in women. Therefore, we analyzed gonadal function and fertility. Patients and methods Women ≤45 years in ongoing remission at least 1 year after therapy were included. Hormone parameters, menopausal symptoms, measures to preserve fertility, menstrual cycle, pregnancies, and offspring were evaluated. Results Three hundred and thirty one of 579 women addressed participated (57.2%) and 263 per-protocol treated patients qualified (A=ABVD: 137, B=2+2: 126, mean time after therapy 42 and 43 months, respectively). Regular menstrual cycle after treatment (A: 87%, B: 83%) and time to recovery (≤12 months) were not different. Follicle-stimulating hormone and anti-Muellerian hormone were significantly better in arm A. However, pregnancies after therapy favored arm B (A: 15%, B: 26%, P=0.043) and motherhood rates were equivalent to the German normal population. Multivariate analysis revealed prophylactic use of gonadotropin-releasing hormone (GnRH) analogues as highly significant prognostic factor for preservation of fertility (odds ratio=12.87, P=0.001). Severe menopausal symptoms were frequent in women ≥30 years (A: 21%, B: 25%). Conclusions Hormonal levels after 2+2 indicate a reduced ovarian reserve. However, 2+2 in combination with GnRH analogues does not compromise fertility within the evaluated observation time