Fertility in young women after chemotherapy with alkylating agents for Hodgkin and non-Hodgkin lymphomas.
BACKGROUND
Owing to improved lymphoma cure rates, preserving fertility has received attention.


METHODS
Women under 40 years at diagnosis of lymphoma, treated with >/=3 chemotherapy cycles including alkylating agents and no pelvic or total body irradiation were selected. A total of 84 women fullfiled these criteria with a median age at diagnosis at 27.4 years, the duration of first-line chemotherapy ranged from 3 to 36 months (median: 7 months) and 17 women received consolidation with high-dose therapy (HDT). After complete remission, 16 women relapsed and received second-line regimen followed by HDT for 9 months.


RESULTS
With a median follow-up of 100 months, 31 women became pregnant, 34 women had primary ovarian failure (POF) and 19 women retained relative fertility. While women with preserved or relative fertility had the same clinical characteristics those with POF were older at diagnosis (30.6 versus 24.3 years), relapsed more often (34 versus 8%) and received HDT more often (54 versus 16%). After HDT (n=26), only three women (25-27 years) became pregnant.


CONCLUSIONS
Women given alkylating agents have a high risk of POF if they are older than 30 years at diagnosis and older than 25 years at the time of HDT. For these women with a high chance of cure and who wish to be pregnant after treatment, regimens with fewer alkylating agents should be proposed or cryopreservation of embryos when possible.
Service d'Hémato-oncologie, Hôpital Saint Louis AP/HP, Paris, France. pauline.brice@sls.ap-hop-paris.fr
Patricia
P
Franchi-Rezgui
Philippe
P
Rousselot
Marc
M
Espié
Josette
J
Brière
Jean
J
Pierre Marolleau
Christian
C
Gisselbrecht
Pauline
P
Brice
D000328:Adult; D000367:Age Factors; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005298:Fertility / Q000187:drug effects*; D006689:Hodgkin Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating