{Reference Type}: Journal Article
{Title}: Clinical and self-reported markers of reproductive function in female survivors of childhood Hodgkin lymphoma.
{Author}: Drechsel KCE;Broer SL;Stoutjesdijk FS;Twisk JWR;van den Berg MH;Lambalk CB;van Leeuwen FE;Overbeek A;van den Heuvel-Eibrink MM;van Dorp W;de Vries ACH;Loonen JJ;van der Pal HJ;Kremer LC;Tissing WJ;Versluys B;Kaspers GJL;van Dulmen-den Broeder E;Veening MA; ;
{Journal}: J Cancer Res Clin Oncol
{Volume}: 149
{Issue}: 15
{Year}: 2023 Nov 31
{Factor}: 4.322
{DOI}: 10.1007/s00432-023-05035-z
{Abstract}: <B>OBJECTIVE: </B>To evaluate the impact of treatment for Hodgkin lymphoma (HL) on clinical reproductive markers and pregnancy outcomes.<BR><B>METHODS: </B>This study was embedded within the DCOG LATER-VEVO study; a Dutch, multicenter, retrospective cohort study between 2004 and 2014. Serum anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), inhibin B, antral follicle count (AFC), and self-reported (first) pregnancy outcomes were evaluated in female childhood HL survivors and controls.<BR><B>RESULTS: </B>84 HL survivors and 798 controls were included, aged 29.6 and 32.7 years old at time of assessment. Median age at HL diagnosis was 13.4 years. Cyclophosphamide equivalent dose (CED-score) exceeded 6000 mg/m2 in 56 women and 14 survivors received pelvic irradiation. All clinical markers were significantly deteriorated in survivors (odds-ratio for low AMH (< p10) 10.1 [95% CI 4.9; 20.6]; low AFC (< p10) 4.6 [95% CI 2.1; 9.9]; elevated FSH (> 10 IU/l) 15.3 [95% CI 5.7; 41.1], low Inhibin B (< 20 ng/l) 3.6 [ 95% CI 1.7; 7.7], p < 0.001). Pregnancy outcomes were comparable between survivors and controls (± 80% live birth, ± 20% miscarriage). However, survivors were significantly younger at first pregnancy (27.0 years vs 29.0 years, P = 0.04). Adjusted odds-ratio for time to pregnancy > 12 months was 2.5 [95% CI 1.1; 5.6] in survivors, p = 0.031. Adverse outcomes were specifically present after treatment with procarbazine and higher CED-score.<BR><B>CONCLUSIONS: </B>HL survivors appear to have an impaired ovarian reserve. However, chance to achieve pregnancy seems reassuring at a young age. Additional follow-up studies are needed to assess fertile life span and reproductive potential of HL survivors, in particular for current HL treatments that are hypothesized to be less gonadotoxic.