Fertility and social reintegration after modified CODOX ‐ M/IVAC with or without rituximab: A questionnaire survey of non‐ H odgkin lymphoma

Abstract

Introduction: Although malignant lymphoma is one of the most common malignancies among adolescents and young adults (AYAs), there has been limited information regarding their long-term outcome after completion of anti-lymphoma therapies, especially for non-Hodgkin lymphoma. Modified (m) CODOX-M/IVAC ± rituximab (R) therapy is one of the most frequently applied intensive regimens, mainly for patients (pts) with Burkitt lymphoma (BL) and primary mediastinal large B-cell lymphoma (PMBL) at our institution [Int J Hematol. 2010 and Hematol Oncol. 2013]. We aimed to investigate the long-term outcome after mCODOX-M/IVAC ± R therapy focusing on fertility and social reintegration. Methods: We conducted a questionnaire survey of pts with BL or PMBL who underwent mCODOX-M/IVAC ± R as an initial therapy between 2003 and 2015 at our institution. Quality of life (QOL) was assessed using the 36-Item Short Form Health Survey (SF-36) version 2. Results: A total of 65 pts were eligible; however, 5 pts were lost to follow-up. Finally, 60 pts (16 BL and 44 PMBL) were identified as subjects of this study. At the time of abstract preparation, 75% (45 pts: 29 females and 16 males) of questionnaires were retrieved. Median age at diagnosis was 34 years (range, 16-55) and median follow-up duration was 6 years (range, 1-16). of 26 premenopausal females at initial diagnosis, fertility preservation was performed in 8 pts (30%) as follows: gonadotropin-releasing hormone analog (7), embryo cryopreservation (2) and oocyte cryopreservation (1). Menstrual recovery was observed in 21 out of the 26 premenopausal pts (80%) after completion of therapy with a median of 2.3 months, whereas 5 (19%) became amenorrheic. of 16 males, sperm cryopreservation had been performed in 6 (38%). After the end of therapy, 5 pregnancies and 3 deliveries were observed. Regarding marital status, 3 were divorced and 5 got married. Furthermore, all 4 students returned to school within 7 months after the therapy. of 36 working adults, 25 pts (69%) came back to their full-time work with a median of 4 months after completion of the therapy. The SF-36 showed that the physical component summary score of all pts was higher than Japanese national norms and the other summary scores were also comparable with the norms. Conclusions: To the best of our knowledge, this is the first report evaluating QOL after mCODOX-M/IVAC ± R therapy. Our findings (Table Presented) demonstrate that this intensive regimen retains the potential for reproduction and social reintegration in pts with BL and PMBL, including AYAs.