Fertility and gonadal function in female survivors after treatment of early unfavorable hodgkin lymphoma (HL) within the German Hodgkin Study Group HD14 trial

Abstract

Background: In the HD14 trial, 2× BEACOPP. escalated + 2× ABVD (2 + 2) has improved the primary outcome. Compared with 4× ABVD, this benefit might be compromised by more infertility in women. Therefore, we analyzed gonadal function and fertility. Patients and methods: Women ≤45 years in ongoing remission at least 1 year after therapy were included. Hormone parameters, menopausal symptoms, measures to preserve fertility, menstrual cycle, pregnancies, and offspring were evaluated. Results: Three hundred and thirty one of 579 women addressed participated (57.2%) and 263 per-protocol treated patients qualified (A = ABVD: 137, B = 2 + 2: 126, mean time after therapy 42 and 43 months, respectively). Regular menstrual cycle after treatment (A: 87%, B: 83%) and time to recovery (≤12 months) were not different. Follicle-stimulating hormone and anti-Muellerian hormone were significantly better in arm A. However, pregnancies after therapy favored arm B (A: 15%, B: 26%, P = 0.043) and motherhood rates were equivalent to the German normal population. Multivariate analysis revealed prophylactic use of gonadotropin-releasing hormone (GnRH) analogues as highly significant prognostic factor for preservation of fertility (odds ratio = 12.87, P = 0.001). Severe menopausal symptoms were frequent in women ≥30 years (A: 21%, B: 25%). Conclusions: Hormonal levels after 2 + 2 indicate a reduced ovarian reserve. However, 2 + 2 in combination with GnRH analogues does not compromise fertility within the evaluated observation time. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.