Clinical and self-reported markers of reproductive function in female survivors of childhood Hodgkin lymphoma

被引:3
作者
Drechsel, K. C. E. [1 ,2 ,3 ]
Broer, S. L. [4 ]
Stoutjesdijk, F. S. [2 ]
Twisk, J. W. R. [5 ]
van den Berg, M. H. [1 ]
Lambalk, C. B. [6 ]
van Leeuwen, F. E. [7 ]
Overbeek, A. [8 ]
van den Heuvel-Eibrink, M. M. [2 ,9 ]
van Dorp, W. [10 ]
de Vries, A. C. H. [2 ,9 ]
Loonen, J. J. [11 ]
van der Pal, H. J. [2 ]
Kremer, L. C. [3 ]
Tissing, W. J. [2 ,12 ]
Versluys, B. [2 ,13 ]
Kaspers, G. J. L. [1 ,2 ]
van Dulmen-den Broeder, E. [1 ]
Veening, M. A. [1 ,2 ]
LATER-VEVO study grp
机构
[1] Vrije Univ Amsterdam, Emma Childrens Hosp, Amsterdam UMC, Pediat Oncol, Amsterdam, Netherlands
[2] Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands
[3] Amsterdam UMC, Canc Ctr Amsterdam, Locat VUmc, Amsterdam, Netherlands
[4] Univ Med Ctr Utrecht, Dept Reprod Med & Gynecol, Utrecht, Netherlands
[5] Vrije Univ Amsterdam, Dept Epidemiol & Data Sci, Amsterdam UMC, Amsterdam, Netherlands
[6] Vrije Univ Amsterdam, Dept Obstet & Gynaecol, Amsterdam UMC, Amsterdam, Netherlands
[7] Netherlands Canc Inst, Dept Epidemiol, Amsterdam, Netherlands
[8] Northwest Clin, Dept Obstet & Gynaecol, Alkmaar, Netherlands
[9] Erasmus MC, Univ Med Ctr Rotterdam, Sophia Childrens Hosp, Dept Paediat Hematooncol, Rotterdam, Netherlands
[10] Erasmus Univ, Dept Obstet & Gynecol, Div Reprod Endocrinol & Infertil, Med Ctr, Rotterdam, Netherlands
[11] Radboud Univ Nijmegen, Radboudumc Ctr Expertise Canc Survivorship, Dept Hematol, Med Ctr, Nijmegen, Netherlands
[12] Univ Groningen, Univ Med Ctr Groningen, Beatrix Childrens Hosp, Groningen, Netherlands
[13] Univ Med Ctr Utrecht, Wilhelmina Childrens Hosp, Dept Heamatol, Utrecht, Netherlands
关键词
Childhood Hodgkin lymphoma; Ovarian reserve; Anti-Mullerian hormone; Reproductive ability; Pregnancy; ANTI-MULLERIAN HORMONE; CANCER SURVIVORS; GONADAL-FUNCTION; OVARIAN RESERVE; PREGNANCY OUTCOMES; CHEMOTHERAPY; FERTILITY; PARENTHOOD; ADOLESCENT; WOMEN;
D O I
10.1007/s00432-023-05035-z
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
PurposeTo evaluate the impact of treatment for Hodgkin lymphoma (HL) on clinical reproductive markers and pregnancy outcomes.MethodsThis study was embedded within the DCOG LATER-VEVO study; a Dutch, multicenter, retrospective cohort study between 2004 and 2014. Serum anti-Mullerian 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.Results84 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/m(2) 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 (& PLUSMN; 80% live birth, & PLUSMN; 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.ConclusionHL 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.
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页码:13677 / 13695
页数:19
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