Fertility status among women treated for aggressive non-Hodgkin's lymphoma
- 1 January 2006
- journal article
- Published by Informa UK Limited in Leukemia & Lymphoma
- Vol. 47 (4), 623-627
- https://doi.org/10.1080/10428190500353877
Abstract
In young women treated for intermediate-high-grade non-Hodgkin's lymphoma with CHOP (cyclophosphamide, adriamycin, oncovine and prednisone), there is insufficient data concerning gonadotoxicity or the need for fertility-preserving measures. The aim of the present study was to evaluate the fertility status in the first complete remission of women who were treated for aggressive non-Hodgkin's lymphoma. A cohort of 36 women with aggressive non-Hodgkin's lymphoma in first remission, who were treated in five university-affiliated hospitals in Israel, was evaluated. All women were aged younger than 40 years at diagnosis and received frontline protocols, including cyclophosphamide and adriamycin, mostly CHOP. Menstrual cycle characteristics, as well as pregnancies before the diagnosis, during treatment and in first complete remission, were evaluated. The patients' mean age at the diagnosis was 28 +/- 7 years (range 17 - 40 years). All patients were treated with chemotherapy, although 10 patients received additional radiotherapy. Follow-up time at first complete remission was 84 +/- 48 months. Before diagnosis, all patients had menstrual cycles, which were regular in 31 (86%). Three patients received gonadtropin-releasing hormone analogs, whereas nine received contraceptive pills together with cytotoxic treatment. During treatment, 18 patients (50%) had amenorrhea, six (17%) had irregular menstrual cycles, and 12 (33%) continued their regular cycles. All but two women resumed menses in the first complete remission, and these were regular in 22 (61%) patients. In 63% of patients, the menstrual cycle recovered within 3 months of the discontinuation of chemotherapy. Eighteen patients (50%) became pregnant during the first complete remission. There was no significant difference between those patients who received fertility-preserving measures versus the remainder concerning regular menstrual cycles recovery or pregnancies. The two patients who developed amenorrhea were 40 years old at the time of diagnosis. In conclusion, the rate of gonadal dysfunction is very low among young, CHOP treated, non-Hodgkin's lymphoma female patients. Fertility-preserving techniques are not needed for women aged younger than 40 years and should probably be reserved for those who are at high risk for gonadal toxicity.Keywords
This publication has 16 references indexed in Scilit:
- Fertility in young women after chemotherapy with alkylating agents for Hodgkin and non-Hodgkin lymphomasThe Hematology Journal, 2003
- Non-Hodgkin's lymphoma: long-term survivors and adverse effectsAnnals Of Oncology, 2000
- Preservation of fertility and ovarian function and minimizing chemotherapy-induced gonadotoxicity in young womenJournal of the Society for Gynecologic Investigation, 1999
- Ovarian Injury and Modern Options to Preserve Fertility in Female Cancer Patients Treated with High Dose Radio-Chemotherapy for Hemato-Oncological Neoplasias and other CancersLeukemia & Lymphoma, 1999
- Late effects in long-term survivors of high-grade non-Hodgkin's lymphomas.Journal of Clinical Oncology, 1998
- Long-term gonadal toxicity after therapy for Hodgkin's and non-Hodgkin's lymphomaAnnals of Hematology, 1994
- Gonadal function after MACOP-B or VACOP-B with or without dose intensification and ABMT in young patients with aggressive non-Hodgkin's lymphomaAnnals Of Oncology, 1993
- Original article: Long-term outcome and sequelae in aggressive lymphoma patients treated with the LNH-80 regimenAnnals Of Oncology, 1992
- Gonadal toxicity after combination chemotherapy for Hodgkin's disease. Comparative results of MOPP vs ABVDEuropean Journal of Cancer and Clinical Oncology, 1985
- National cancer institute sponsored study of classifications of non-hodgkin's lymphomas. Summary and description of a working formulation for clinical usageCancer, 1982