Gonadotropin-releasing hormone agonist decreases chemotherapy-induced gonadotoxicity and premature ovarian failure in young female patients with Hodgkin lymphoma.
OBJECTIVE
To minimize the gonadotoxic effect of chemotherapy by the cotreatment with a GnRH agonistic analogue (GnRH-a).


METHODS
Prospective nonrandomized study with concurrent and historical controls.


METHODS
University medical center.


METHODS
One hundred fifteen female patients with Hodgkin lymphoma (HL).


METHODS
Sixty-five patients received a monthly injection of GnRH-a, administered before starting chemotherapy until its conclusion, up to a maximum of 6 months. Thirty-five patients were treated with ABVD and 76 with a procarbazine-containing regimen. This group was compared with a control group of 46 women who were treated concurrently with similar chemotherapy (n = 26) without GnRH-a or were historical controls (n = 20).


METHODS
Cyclic ovarian function (COF) versus premature ovarian failure (POF).


RESULTS
The ovarian function could be determined in 111 patients. In the GnRH-a/chemotherapy group, 63 out of 65 patients resumed ovulation and regular menses (96.9 %), compared with 63% of the 46 control subjects. Twenty of the 22 patients in the BEACOPP/escalated BEACOPP/GnRH-a cotreatment resumed cyclic ovarian function versus 9 of the 14 in the chemotherapy-only group. All 17 MOPP/ABV/GnRH-a cotreated patients resumed COF versus 11 of the 22 in the chemotherapy-only group. There was no significant effect of the GnRH-a cotreatment regarding COF in the ABVD group. There were no significant differences in the cumulative doses of the various alkylating agents between the two groups.


CONCLUSIONS
Cotreatment with GnRH-a may reduce ovarian damage significantly in female patients treated for HL and should be considered in addition to assisted reproduction for women in reproductive age receiving gonadotoxic chemotherapy.
Blumenfeld
Zeev
Z
Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. bzeev@techunix.technion.ac.il
Avivi
Irith
I
Eckman
Ari
A
Epelbaum
Ron
R
Rowe
Jacob M
JM
Dann
Eldad J
EJ
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007267:Injections; D008597:Menstrual Cycle / Q000187:drug effects*; D010053:Ovary / Q000187:drug effects* / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D017329:Triptorelin Pamoate / Q000008:administration & dosage*
D005300:Fertility Agents, Female; D017329:Triptorelin Pamoate; D007987:Gonadotropin-Releasing Hormone